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.

Objective: This study aimed to clarify the effectiveness of cervical cerclage in preventing recurrent preterm births. Design: A retrospective study. Setting: The perinatal registration database of the Japan Society of Obstetrics and Gynecology Perinatal Center from 2014 to 2016. Population or Sample: For this study, 6,060 multiparous women with a history of preterm birth were reviewed. After excluding 17 subjects who had unknown indications for cervical cerclage, 6,043 subjects were included in this study. Methods and main outcome measures: The efficacies of elective, ultrasound-indicated, and emergency cerclage as preventive treatments for women with a history of preterm birth were evaluated by comparing the cerclage and non-cerclage cases. Prior to evaluation, a propensity score matching was performed for elective and ultrasound-indicated cerclage patients. Results: Elective cerclage did not reduce the risk of preterm birth in subsequent pregnancies for any of the pregnancy periods (p = 0.413). Similarly, ultrasound-indicated cerclage was ineffective (p = 1.000). In addition, for ultrasound-indicated cerclage, Kaplan-Meier survival curves showed that the risk of a subsequent preterm birth might increase at < 33 weeks of gestation. However, the hazard ratio could not be determined to be statistically significant using the log-rank test at < 28 weeks of gestation. In contrast, emergency cerclage significantly reduced the risk of subsequent preterm birth for all pregnancy periods (p < 0.001). Conclusions: Subsequent preterm births were effectively prevented only in emergency cerclage cases. For elective and ultrasound-indicated cerclage, statistically significant differences in subsequent preterm births were not evident.