Fetal heart rate patterns in cerebral palsy associated with umbilical
cord troubles: Nationwide cohort study
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.