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.