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Fetal heart rate patterns in cerebral palsy associated with umbilical cord troubles: Nationwide cohort study
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  • Satoru Takeda,
  • JUNICHI HASEGAWA,
  • Masahiro Nakao,
  • Tomoaki Ikeda,
  • Satoshi Toyokawa,
  • Emi Jojima,
  • Shoji Satoh,
  • Kiyotake Ichizuka,
  • Nanako Tamiya,
  • Akihito Nakai,
  • Keiya Fujimori,
  • Tsugio Maeda,
  • Hideaki Suzuki,
  • Mitsutoshi Iwashita,
  • Tsuyomu Ikenoue
Satoru Takeda
Juntendo University
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JUNICHI HASEGAWA
St. Marianna University School of Medicine

Corresponding Author:dr.hasejun@outlook.com

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Masahiro Nakao
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Tomoaki Ikeda
Mie University Graduate School of Medicine Faculty of Medicine
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Satoshi Toyokawa
The University of Tokyo
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Emi Jojima
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Shoji Satoh
Oita Prefectural Hospital
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Kiyotake Ichizuka
Showa University Northern Yokohama Hospital
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Nanako Tamiya
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Akihito Nakai
Nippon Medical School
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Keiya Fujimori
Fukushima Medical University
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Tsugio Maeda
Maeda Clinic
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Hideaki Suzuki
Japan Council for Quality Health Care
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Mitsutoshi Iwashita
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Tsuyomu Ikenoue
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Abstract

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.