Introduction
Although intrapartum hypoxia-ischemia is associated with cerebral palsy
(CP), many CP cases’ etiology remains unknown.1A
systematic review found that CP associated with intrapartum
hypoxia-ischemia accounted for 14.5% of CP in developed countries, and
the incidence of CP has persisted over the past 30
years.1 Placental and umbilical cord abnormalities are
likely to induce fetal hypoxia, and the association between CP
development and these abnormalities has been previously
reported.2-4
The pathology of umbilical cord abnormality might be associated with its
vulnerability to the external force during uterine contraction,
resulting in acute intrapartum hypoxia-ischemia. However, the pattern
and extent of deterioration in umbilical blood flow might vary depending
on the type of umbilical cord abnormalities. A recently published
nationwide study showed that the umbilical cord troubles were
responsible for one-fourth of CP in term or near-term
infants.5 This study also classified each CP case into
five fetal heart rate (FHR) pattern categories. The FHR pattern
evolution suggests the timing of fetal brain injury, which is expected
to be critical considerations for the provision of safe delivery.
Therefore, we focused on these notable features in elucidating CP
associated with the umbilical cord troubles. We hypothesized that the
FHR pattern evolution provides clues to prevent cord-related brain
damage. The objective was to identify the FHR patterns in patients with
CP associated with cord problems.