OBJECTIVE. To review the relationship between cerebral palsy and the birth process.

DATA SOURCES. Medline and non-Medline literature search and personal experience.

STUDY SELECTION. Articles that commented on the routinely used markers of foetal distress, such as abnormal foetal heart rate, meconium-stained liquor, and foetal acidosis.

DATA EXTRACTION. Data were extracted and reviewed independently by both authors.

DATA SYNTHESIS. The use of meconium alone as a predictor of cerebral palsy has a high false-positive rate of up to 99.6%. No specific foetal heart rate pattern that can accurately predict subsequent neurological impairment, and a low Apgar score is not by itself an indication of intrapartum asphyxia. The presence of encephalopathy in a neonate after birth and the association of multi-organ system dysfunction are important clues to the prior occurrence of foetal asphyxia.

CONCLUSION. Cerebral palsy can be caused by asphyxia associated with the birth process. To be able to attribute cerebral palsy to peripartum asphyxia, there should be a sequence of signs during labour, delivery, and the perinatal period. Honest and sympathetic discussion between the obstetrician, paediatrician, and parents is critical throughout the counselling process.

Key words: Apgar score; Asphyxia neonatorum; Brain damage, chronic; Cerebral palsy

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