Cerebral palsy following cutting of the nuchal cord before delivery

Five cases identified in the course of medicolegal reviews are described where the umbilical cord wrapped around the neck of the foetus once was cut intentionally, or broken, prior to the extraction of the body. Delivery was delayed on account of shoulder dystocia for a period of time varying from three to seven minutes. All of these infants were born with a low APGAR score. Subsequently, they displayed manifestations of cerebral palsy and two of them also had permanent brachial plexus lesion. This series of incidents indicates that an unexpected arrest of the shoulders may inadvertently compound the problem that the severing of the cord prior to the delivery of the body entails. If, as in the cases presented here, hypoxic brain damage ensues, the severing of the cord may become a suspected causative factor. Our literary review has revealed no reference to severing of the cord having been followed by shoulder dystocia. Along with other instances where similar reviews drew attention to as yet unrecognized clinical phenomena, this unusual cluster of a previously unconsidered type of accident at birth underlines the value of carefully conducted medicolegal reviews as a potential clinical research tool in medicine.