VALENCIA, Spain—A new approach called the fetal reserve index can more accurately identify babies born with cerebral palsy, according to Mark Evans, MD, a professor at Mount Sinai School of Medicine, in New York, New York, and the founder, chief scientific officer, and president of the Fetal Medicine Foundation of America.

The approach could also reduce the rates of emergency Cesarean sections as well as vaginal operative deliveries.

The fetal reserve index “shows much better detection of risk for neurological impairment and cerebral palsy,” Dr. Evans said at the 20th World Congress in Fetal Medicine held here.

He explained that the index takes into account fetal heart rate, baseline variability, acceleration, decelerations, increased uterine activity, maternal risk factors, obstetrical risk factors including labor, and fetal risk factors, with each category scoring 1 if normal and 0 if not.

Mark Evans, MD, delivers a special lecture at the 20th World Congress in Fetal Medicine. (Photo by Özge Özkaya)

The fetal reserve index scores and fetal pH and base excess fall early in the first stage of labor and provide a good surrogate for pH and base excess values, according to Dr. Evans. The last fetal reserve index score before delivery together with the early analysis of neonatal heart rate and acid/base balance showed that the period of risk for neurologic impairment in a newborn baby can continue for the first 30 minutes of life and needs to be observed much more closely than it currently is.

Finally, Dr. Evans touched on the genetics of cerebral palsy and said that all patients with a diagnosis of cerebral palsy should receive genomic sequencing. This can result in the identification of subcategories with different degrees of severity and different levels of susceptibility to stress during labor. 

“Better differentiation of the genetic status of cerebral palsy cases will allow proper segregation of those cases that might be preventable from those that are not,” Dr. Evans said. “Only then can we optimize early detection of preventable risks during antepartum, intrapartum, and postpartum time periods.”

Cerebral palsy is a condition caused by damage to the brain that occurs before, during, or just after birth and is associated with coordination and speech problems. The exact cause of cerebral palsy is not clear and ranges from genetic mutation to mismanagement of labor.


Evans M. Contribution of genetics to cerebral palsy. Oral presentation at: 20th World Congress in Fetal Medicine; June 28, 2023; Valencia, Spain.