Strengths and limitations
The strength of this nationwide analysis highlighted the features of FHR
evolution patterns in infants with severe CP associated with umbilical
cord troubles. We also identified some factors that have the potential
of preventing CP based on FHR pattern analysis.
Despite these strengths, the current research also has several
limitations. First, this is a retrospective observational study without
a control group. Furthermore, we collected only severe CP cases with a
birth weight of ≥2000 g and at the gestational age of ≥33 weeks, and we
analyzed only available data. Therefore, the present study may have a
collection bias. Second, we were not able to infer the associations
among CP, umbilical cord abnormalities, fetal growth restriction, and
pathological findings of the placenta that were not sufficiently
available in this cohort.
We need further analysis, including milder forms of CP cases, to
generalize our result. Furthermore, larger case-control studies and
prospective cohort studies will be needed to determine whether each
umbilical cord trouble itself is associated with the specific FHR
pattern.