Labor induction by transcervical balloon catheter and cerebral palsy associated with umbilical cord prolapse

The aim of this study was to determine whether the use of transcervical balloon catheter (TCBC) for induction of labor (IOL) is a risk factor for cerebral palsy (CP) associated with umbilical cord prolapse (UCP-CP) in singleton pregnancies with cephalic presentation.

Among all 102 infants with CP who were preliminarily determined as caused by antenatal and/or intrapartum hypoxemia by the Japan Council for Quality Health Care until April 2012, all 56 infants who met all of the following criteria were studied: cephalic singleton pregnancy, reassuring fetal status on electronic cardiotocogram at time of admission to obstetric facilities for labor pains, ruptured fetal membranes, and/or IOL, and hypoxic-ischemic encephalopathy at birth. Clinical backgrounds were compared between six infants with UCP-CP and the remaining 50 infants with CP not associated with UCP (non-UCP-CP).

Frequencies of IOL (83% [5/6] vs 32% [16/50], P = 0.0236), use of TCBC (67% [4/6] vs 10% [5/50], P = 0.0044), and amniotomy (67% [4/6] vs 24% [12/50], P = 0.0494) were significantly higher in the UCP-CP than the non-UCP-CP group. Only TCBC was a risk factor significantly associated with UCP-CP after logistic regression analysis, yielding an odds ratio of 18.0 (95% confidence interval, 2.6-124; P = 0.003). Saline volumes of 80-150 mL were used for TCBC inflation in the four UCP-CP patients.

Use of TCBC with a saline volume ≥ 80 mL was a significant risk factor for UCP-CP; however, the absolute risk of UCP-CP was estimated to be very low, approximately one in 7875 TCBC users.