Objective: To clarify the fetal heart rate (FHR) pattern evolution and estimate the timing of brain injury in infants with cerebral palsy (CP) according to each of the umbilical cord (UC) troubles. Design: Longitudinal cohort study using the nationwide registry. Setting: Children with CP who were approved for disability support by the Japan Obstetric Compensation System for CP. Population: 126 infants with severe CP caused by UC troubles with a birth weight of 2000 g and 33 weeks of gestational age. Methods: Observers classified the intrapartum FHR strips into five groups: (1) the persistent bradycardia (P-Brady); (2) the persistently non-reassuring (P-NR); (3) Hon’s pattern; (4) the reassuring-prolonged deceleration (R-PD); and (5) the persistently reassuring (P-R). Main outcome measures: Timing and type of evolution patterns of abnormal FHR stratified by various UC troubles. Results: Of 126 cases, 32 were associated with umbilical cord prolapse, and 94 were with other UC morphological abnormalities. Overall, nearly half of the eligible cases had intrapartum onset with R-PD (43%). Meanwhile, around half of those associated with UC morphological abnormalities had an antenatal onset. In the intrapartum setting, most of the FHR deteriorations occurred during the first stage of labor, and there was a high incidence of Hon’s pattern in the case with velamentous insertion and multiple entanglements. Conclusion: Infants with severe CP associated with the UC troubles were characterized as sudden onset during the first stage of labor. Around half of those due to the UC morphological abnormalities were presumed to have an antenatal onset.