title: Relevant Obstetric Factors for Cerebral Palsy: From the Nationwide Obstetric Compensation System in Japan.
abstract: OBJECTIVE
  The aim of this study was to identify the relevant obstetric factors for cerebral palsy (CP) after 33 weeks' gestation in Japan.
  
  
  METHODS
  This retrospective case cohort study (1:100 cases and controls) used a Japanese national CP registry. Obstetric characteristics and clinical course were compared between CP cases in the Japan Obstetric Compensation System for Cerebral Palsy database and controls in the perinatal database of the Japan Society of Obstetrics and Gynecology born as live singleton infants between 2009 and 2011 with a birth weight ≥ 2,000 g and gestation ≥ 33 weeks.
  
  
  RESULTS
  One hundred and seventy-five CP cases and 17,475 controls were assessed. Major relevant single factors for CP were placental abnormalities (31%), umbilical cord abnormalities (15%), maternal complications (10%), and neonatal complications (1%). A multivariate regression model demonstrated that obstetric variables associated with CP were acute delivery due to non-reassuring fetal status (relative risk [RR]: 37.182, 95% confidence interval [CI]: 20.028-69.032), uterine rupture (RR: 24.770, 95% CI: 6.006-102.160), placental abruption (RR: 20.891, 95% CI: 11.817-36.934), and preterm labor (RR: 3.153, 95% CI: 2.024-4.911), whereas protective factors were head presentation (RR: 0.199, 95% CI: 0.088-0.450) and elective cesarean section (RR: 0.236, 95% CI: 0.067-0.828).
  
  
  CONCLUSIONS
  CP after 33 weeks' gestation in the recently reported cases in Japan was strongly associated with acute delivery due to non-reassuring fetal status, uterine rupture, and placental abruption.
authors.affiliation: Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Hasegawa
authors.affiliation: Department of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Toyokawa
authors.affiliation: President, The University of Miyazaki, Miyazaki, Japan.
authors.forename: Tsuyomu
authors.initials: T
authors.lastname: Ikenoue
authors.affiliation: Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Asano
authors.affiliation: Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Satoh
authors.affiliation: Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
authors.forename: Kiyotake
authors.initials: K
authors.lastname: Ichizuka
authors.affiliation: Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Nanako
authors.initials: N
authors.lastname: Tamiya
authors.affiliation: Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Nakai
authors.affiliation: Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Keiya
authors.initials: K
authors.lastname: Fujimori
authors.affiliation: Maeda Clinic, Incorporated association Anzu-kai, Shizuoka, Japan.
authors.forename: Tsugio
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Department of Obstetrics and Gynecology, The University of Nagasaki, Nagasaki, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Masuzaki
authors.affiliation: Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ueda
mesh_terms: D000328:Adult; D001724:Birth Weight; D002547:Cerebral Palsy / Q000453:epidemiology*; D002585:Cesarean Section / Q000009:adverse effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011247:Pregnancy; D012189:Retrospective Studies
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