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Fetal heart rate evolution patterns in cerebral palsy associated with umbilical cord complications: a nationwide

Junichi Hasegawa1,2, Masahiro Nakao3,4,5, Tomoaki Ikeda4,6

  • 1Visiting Researcher, Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan. hasejun@marianna-u.ac.jp.

BMC Pregnancy and Childbirth
|March 4, 2022
PubMed

Insights

Fetal heart rate (FHR) patterns differ in infants with cerebral palsy (CP) based on umbilical cord complications. Umbilical cord prolapse and antenatal complications are linked to non-reassuring FHR patterns and prolonged decelerations.

Area of Science:

  • Perinatal Medicine
  • Neonatology
  • Obstetrics

Background:

  • Cerebral palsy (CP) is a significant concern in infant health.
  • Umbilical cord complications are potential contributors to adverse neonatal outcomes.
  • Understanding fetal heart rate (FHR) patterns is crucial for assessing fetal well-being.

Purpose of the Study:

  • To investigate the relationship between different types of umbilical cord complications and fetal heart rate (FHR) evolution patterns in infants diagnosed with cerebral palsy (CP).
  • To differentiate FHR patterns associated with specific umbilical cord issues like prolapse versus antenatal complications.

Main Methods:

  • A case-control study design was employed.
  • Included were infants born between 2009-2014 with birth weight ≥2000g, gestational age ≥33 weeks, and diagnosed with CP.
  • Fetal heart rate (FHR) patterns and obstetric characteristics were compared between infants with CP and umbilical cord complications (126 cases) and those without (594 controls).

Main Results:

  • Persistent non-reassuring FHR patterns were more prevalent in CP cases with coexistent antenatal umbilical cord complications (p=0.012).
  • Prolonged decelerations, particularly during the first stage of labor, were significantly more frequent in infants with umbilical cord prolapse (69%) and antenatal cord complications (35%) compared to controls (17%) (p<0.001).

Conclusions:

  • Specific umbilical cord abnormalities, such as hypercoiled cord and abnormal placental insertion, may contribute to CP through chronic or acute hypoxic-ischemic events during pregnancy.
  • Umbilical cord prolapse is strongly associated with acute hypoxic-ischemic injury occurring during the delivery process.
Abstract

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