title: Intrapartum risk factors for neonatal encephalopathy leading to cerebral palsy in women without apparent sentinel events.
abstract: OBJECTIVE
  To determine intrapartum factors associated with neonatal encephalopathy leading to cerebral palsy (NE-CP).
  
  
  METHODS
  A total of 70 NE-CP patients who fulfilled study criteria (cephalic singleton pregnancy with attempted vaginal delivery [AVD] at gestational week [GW] ≥36; intrapartum occurrence of non-reassuring fetal status without apparent cause following reassuring fetal status on admission; and development of NE-CP) were compared with 210 AVD controls who had 1- and 5-min Apgar score ≥8 matched for GW, maternal parity, and use of uterotonics. Suboptimal care was defined as delayed reaction due to misinterpretation of fetal heart rate (FHR) tracing, or inappropriate trial of instrumental delivery (TOID). Successful and failed TOID were defined as vaginal and cesarean delivery after TOID, respectively. The 210 controls were assumed not to have had suboptimal care.
  
  
  RESULTS
  The rates of successful (34% vs 12%) and failed TOID (11% vs 0.0%), cesarean section (34% vs 14%), suboptimal care (57% vs 0.0%), pregnancy-induced hypertension (11% vs 2.4%), birthweight ≥3800 g (8.6% vs 1.9%), subgaleal hemorrhage (16% vs 0.0%) were significantly higher in NE-CP patients than in controls. Selection with the stepwise method and logistic regression analysis identified four independent risk factors for NE-CP: suboptimal intrapartum care (OR, 2.21; 95%CI: 1.99-2.47), cesarean section (OR, 1.19; 95%CI: 1.08-1.31), successful TOID (OR, 1.14; 95%CI: 1.03-1.25), and hypertension (OR, 1.20; 95%CI: 1.01-1.42).
  
  
  CONCLUSIONS
  Training programs for improved interpretation of FHR tracing and appropriate TOID are required to prevent NE-CP among healthy and mature fetuses in Japan.
authors.affiliation: Department of Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Cho
authors.affiliation: Department of Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Morikawa
authors.affiliation: Department of Obstetrics and Gynecology, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Hisanori
authors.initials: H
authors.lastname: Minakami
mesh_terms: D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012307:Risk Factors
keywords: fetal heart rate tracing; instrumental delivery; macrosomia; non-reassuring fetal status; shoulder dystocia; vacuum delivery