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Taylor and Francis Group, RNA Biology, 2(10), p. 175-179, 2013

DOI: 10.4161/rna.23175

Taylor and Francis Group, Plant Signaling & Behavior, 11(7), p. 1493-1494, 2012

DOI: 10.4161/psb.21893

Hindawi, Oxidative Medicine and Cellular Longevity, 5(3), p. 325-331, 2010

DOI: 10.4161/oxim.3.5.13109

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Debt and input misallocation

Journal article published in 1990 by Bo Liu, Bingtao Zhu, Leonie de Boer, Xiaodong Zhang, Bruna de Souza, Antônio W. Zuardi, Wei Sen Zhang, Sebastian A. J. Zaat, Dong Zhang, A. C. van Rossum, Maja Łebska, Xingzhi Xu, W. S. Yancy, J. Wylie-Rosett, Michael W. White and other authors.
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

The cause of the majority of cases of cerebral palsy (CP) and epilepsy remains speculative. The physician and pregnant mother generally regard the fetus as relatively well-protected from physical harm in utero. Postnatal shaken-baby syndrome and cranial blows sufficient to cause loss of consciousness are well-established etiologies of both; intracranial forces sufficient to produce a similar effect can occur in utero. This presentation is intended to demonstrate how relatively trivial pressure from ultrasound-guided external palpation can cause remarkable compression and movement of fetal parts. A pregnant mother could place her fetus at risk by lifting a tantruming child, receiving a kick which by chance may be transmitted to the fetal cranium just below the maternal skin surface. She would not recall such an event when signs of CP and/or epilepsy first appear. A pregnant mother with a 1 to 2-year old could be at highest risk of damage. During the third trimester, many fetal heads are maintained in vertex position, and are protected from direct percussive effects by the maternal pubis (easily demonstrated with ultrasound)–which may explain the higher incidence of CP and epilepsy in breech presentations after excluding significant hypoxia. It is also possible that the higher rate of CP in multiple gestations, after excluding effects of prematurity, could be in part due to intrauterine blunt trauma from sudden complete extension of the lower extremity, a common recurrent fetal reflex, directed at a cranium –those who are breech/vertex in the 2nd and 3rd trimester might both be at increased risk, with vertex/vertex in the 3rd trimester at lowest risk (many twins remain fixed in relative presentation in the last 2 months of pregnancy). The most attractive aspect of this theory is that prevention will be possible, through patient and physician awareness of the potential for harm. This hypothesis may be tested, since if valid, firstborn and siblings 4 years or more apart should have significantly lower rates than those born 1 to 2 years apart; a significantly obese abdomen would be protective. Currently it is not standard practice for physicians to warn pregnant women with regard to the possibility of blunt trauma as a potential cause of significant damage to the fetus. Such education about potential danger appears to have little risk to the patient, and the potential of benefit may warrant immediate implementation as a common-sense precaution.