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Murata T, Kyozuka H, Yasuda S, Imaizumi K, Isogami H, Fukuda T, Yamaguchi A, Sato A, Ogata Y, Shinoki K, Hosoya M, Yasumura S, Hashimoto K, Fujimori K, Nishigori H. Nonreassuring fetal status during labor and offspring's childhood neurodevelopment at 3 years of age: The Japan Environment and Children's Study. Int J Gynaecol Obstet 2024; 165:244-255. [PMID: 37984054 DOI: 10.1002/ijgo.15206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Although prior attempts have failed to identify the beneficial effects of intensive fetal monitoring on cerebral palsy, the association between nonreassuring fetal status (NRFS) during labor and the incidence of long-term neurodevelopmental delays in offspring remains unclear. This study aimed to evaluate this association using a nationwide birth cohort. METHODS Data from 72 869 women with singleton deliveries at and after 37 weeks of gestation from the Japan Environment and Children's Study (2011-2014) were analyzed. Multivariable logistic regression models were used to analyze the odds ratios (ORs) for neurodevelopmental delays using the Ages & Stages Questionnaire (Third Edition) in offspring aged 3 years. RESULTS The adjusted ORs for personal-social problems were 1.52 (95% confidence interval [CI], 1.06-2.16) for offspring delivered vaginally by nulliparous mothers and 1.51 (95% CI, 1.05-2.18) (for males, 1.70 [95% CI, 1.15-2.50]) for those delivered via cesarean section. No significant changes in adjusted ORs for neurodevelopmental delays were observed among participants without neonatal Apgar scores (ASs) <7 and without umbilical arterial pH (UmA-pH) <7.20. CONCLUSION NRFS during labor was associated with an increased incidence of personal-social problems in offspring aged 3 years. However, this association was not confirmed after excluding participants with neonatal ASs <7 and UmA-pH <7.20. The association between NRFS and offspring's neurodevelopmental delays might vary based on delivery settings, offspring sex, and short-term neonatal outcomes.
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Affiliation(s)
- Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hyo Kyozuka
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Karin Imaizumi
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hirotaka Isogami
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toma Fukuda
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
| | - Kosei Shinoki
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
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Nakao M, Ross MG, Magawa S, Toyokawa S, Ichizuka K, Kanayama N, Satoh S, Tamiya N, Nakai A, Fujimori K, Maeda T, Oka A, Suzuki H, Iwashita M, Ikeda T. Prevention of fetal brain injury in category II tracings. Acta Obstet Gynecol Scand 2023; 102:1730-1740. [PMID: 37697658 PMCID: PMC10619613 DOI: 10.1111/aogs.14675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION With category II fetal heart rate tracings, the preferred timing of interventions to prevent fetal hypoxic brain damage while limiting operative interventions remains unclear. We aimed to estimate fetal extracellular base deficit (BDecf ) during labor with category II tracings to quantify the timing of potential interventions to prevent severe fetal metabolic acidemia. MATERIAL AND METHODS A longitudinal study was conducted using the database of the Recurrence Prevention Committee, Japan Obstetric Compensation System for Cerebral Palsy, including infants with severe cerebral palsy born at ≥34 weeks' gestation between 2009 and 2014. Cases included those presumed to have an intrapartum onset of hypoxic-ischemic insult based on the fetal heart rate pattern evolution from reassuring to an abnormal pattern during delivery, in association with category II tracings marked by recurrent decelerations and an umbilical arterial BDecf ≥ 12 mEq/L. BDecf changes during labor were estimated based on stages of labor and the frequency/severity of fetal heart rate decelerations using the algorithm of Ross and Gala. The times from the onset of recurrent decelerations to BDecf 8 and 12 mEq/L (Decels-to-BD8, Decels-to-BD12) and to delivery were determined. Cases were divided into two groups (rapid and slow progression) based upon the rate of progression of acidosis from onset of decelerations to BDecf 12 mEq/L, determined by a finite-mixture model. RESULTS The median Decels-to-BD8 (28 vs. 144 min, p < 0.01) and Decels-to-BD12 (46 vs. 177 min, p < 0.01) times were significantly shorter in the rapid vs slow progression. In rapid progression cases, physicians' decisions to deliver the fetus occurred at ~BDecf 8 mEq/L, whereas the "decisions" did not occur until BDecf reached 12 mEq/L in slow progression cases. CONCLUSIONS Fetal BDecf reached 12 mEq/L within 1 h of recurrent fetal heart rate decelerations in the rapid progression group and within 3 h in the slow progression group. These findings suggest that cases with category II tracings marked by recurrent decelerations (i.e., slow progression) may benefit from operative intervention if persisting for longer than 2 h. In contrast, cases with sudden bradycardia (i.e., rapid progression) represent a challenge to prevent severe acidosis and hypoxic brain injury due to the limited time opportunity for emergent delivery.
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Affiliation(s)
- Masahiro Nakao
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Department of Obstetrics and GynecologyMie University Graduate School of MedicineTsuMieJapan
- Department of Obstetrics and GynecologySakakibara Heart InstituteTokyoJapan
| | - Michael G. Ross
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Department of Obstetrics and GynecologyGeffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Shoichi Magawa
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Department of Obstetrics and GynecologyMie University Graduate School of MedicineTsuMieJapan
| | - Satoshi Toyokawa
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Faculty of NursingWayo Women's UniversityChibaJapan
| | - Kiyotake Ichizuka
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Department of Obstetrics and GynecologyShowa University Northern Yokohama HospitalYokohamaKanagawaJapan
| | - Naohiro Kanayama
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Department of Obstetrics and GynecologyHamamatsu University School of MedicineShizuokaJapan
| | - Shoji Satoh
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Maternal and Perinatal Care CenterOita Prefectural HospitalOitaJapan
| | - Nanako Tamiya
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Department of Health Services Research, Faculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Akihito Nakai
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Department of Obstetrics and GynecologyNippon Medical SchoolTokyoJapan
| | - Keiya Fujimori
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Department of Obstetrics and GynecologyFukushima Medical UniversityFukushimaJapan
| | - Tsugio Maeda
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Maeda ClinicIncorporated Association Anzu‐kaiShizuokaJapan
| | - Akira Oka
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Department of PediatricsSaitama Children's Medical CenterSaitamaJapan
| | - Hideaki Suzuki
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
| | - Mitsutoshi Iwashita
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Kugayama HospitalTokyoJapan
| | - Tomoaki Ikeda
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral PalsyJapan Council for Quality Health CareTokyoJapan
- Department of Obstetrics and GynecologyMie University Graduate School of MedicineTsuMieJapan
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Ebbing C, Rasmussen S, Kessler J, Moster D. Association of placental and umbilical cord characteristics with cerebral palsy: national cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:224-230. [PMID: 36722428 PMCID: PMC10108292 DOI: 10.1002/uog.26047] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Cerebral palsy (CP) is a group of movement disorders usually diagnosed in childhood. A substantial proportion are thought to be caused by antenatal events. Abnormalities of the umbilical cord and placenta are associated with an increased risk of adverse neonatal outcomes, but it is unclear whether these conditions also carry an increased risk of CP. We aimed to determine whether abnormalities of the umbilical cord or placenta are associated with CP and assess if these associations differ by sex of the child or gestational age at birth. METHODS We performed a national cohort study by linking data from The Medical Birth Registry of Norway with other national registries. All liveborn singletons born between 1999 and 2017 (n = 1 087 486) were included and followed up until the end of 2019. Diagnoses of CP were provided by the Norwegian National Insurance Scheme and the Norwegian Patient Register. We used generalized estimating equations and multilevel log binomial regression to calculate relative risks (RR), adjusted for year of birth, and stratified analyses were carried out based on sex and gestational age at birth. Exposures were abnormal umbilical cord (velamentous or marginal insertion, single umbilical artery (SUA), knots and entanglement), and placental abnormalities (retained placenta, placental abruption and previa). RESULTS A total of 2443 cases with CP (59.8% males) were identified. Velamentous cord insertion (adjusted RR (aRR), 2.11 (95% CI, 1.65-2.60)), cord knots (aRR, 1.53 (95% CI, 1.15-2.04)) and placental abnormalities (placenta previa (aRR, 3.03 (95% CI, 2.00-4.61)), placental abruption (aRR, 10.63 (95% CI, 8.57-13.18)) and retained placenta (aRR, 1.71 (95% CI, 1.32-2.22))) carried an increased risk of CP. Velamentous cord insertion was associated with CP regardless of gestational age or sex. A retained placenta was associated with a 2-fold increased risk for CP in males, while the associations of SUA and cord knot with CP were significant only among females. CONCLUSIONS The detection of placental and umbilical cord abnormalities may help identify children at increased risk of CP. The associations between placental or umbilical cord abnormalities and the risk of CP do not vary substantially with gestational age at birth or sex of the child. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C. Ebbing
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - S. Rasmussen
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - J. Kessler
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - D. Moster
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
- Department of PediatricsHaukeland University HospitalBergenNorway
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Tegegne KT. Determinants of cerebral palsy in children: systematic review. Sudan J Paediatr 2023; 23:126-144. [PMID: 38380410 PMCID: PMC10876278 DOI: 10.24911/sjp.106-1670589241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/26/2023] [Indexed: 02/22/2024]
Abstract
Cerebral palsy (CP) is a group of disorders of movement and postural control caused by a nonprogressive defect or lesion of the developing brain. Several prepregnancy risk factors have been described including maternal age, parity and maternal diseases including epilepsy, diabetes and thyroid disease. There are few in-depth studies on the causes of CP. In the present systematic review, databases searched were Google Scholar and PubMed to identify data on determinants of CP in the world. Studies were included if they specifically mentioned CP as an outcome, the study objective is to identify factors associated with CP in children and all quantitative observational studies. JBI Critical Appraisal Tools were used to assess the methodological quality of a study. Papers that meet the inclusion criteria were rigorously appraised by two critical appraisers. 40 consistent determinants of CP in children from 95 research articles that meet inclusion criteria are included in the review. The majority of studies (24 articles) showed that premature babies and low weight were determinants of CP in children, whereas 15 studies showed that low Apgar scores were determinants of CP in children. The commonest determinants of CP in children are premature babies and low weight, low Apgar scores, intrauterine infection, congenital brain malformations, thyroid disease, premature rupture of membrane (PROM) and placental abruption. Preventing preterm delivery, low birth weight and intrauterine infection as well as immediate neonatal resuscitation for newborns with low Apgar scores may help to prevent CP in children.
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Affiliation(s)
- Kaleab Tesfaye Tegegne
- Department of Public Health, College of Health Science, Debark University, Debark, Ethiopia
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5
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Oltean I, Rajaram A, Tang K, MacPherson J, Hondonga T, Rishi A, Toltesi R, Gowans R, Jahangirnia A, Nasr Y, Lawrence SL, El Demellawy D. The Association of Placental Abruption and Pediatric Neurological Outcome: A Systematic Review and Meta-Analysis. J Clin Med 2022; 12:jcm12010205. [PMID: 36615006 PMCID: PMC9821447 DOI: 10.3390/jcm12010205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Placental histopathology provides insights, or "snapshots", into relevant antenatal factors that could elevate the risk of perinatal brain injury. We present a systematic review and meta-analysis comparing frequencies of adverse neurological outcomes in infants born to women with placental abruption versus without abruption. Records were sourced from MEDLINE, Embase, and the CENTRAL Trials Registry from 1946 to December 2019. Studies followed the PRISMA guidelines and compared frequencies of neurodevelopmental morbidities in infants born to pregnant women with placental abruption (exposure) versus women without placental abruption (comparator). The primary endpoint was cerebral palsy. Periventricular and intraventricular (both severe and any grades of IVH) and any histopathological neuronal damage were the secondary endpoints. Study methodologic quality was assessed by the Ottawa-Newcastle scale. Estimated odds ratios (OR) and hazards ratio (HR) were derived according to study design. Data were meta-analyzed using a random effects model expressed as pooled effect sizes and 95% confidence intervals. We included eight observational studies in the review, including 1245 infants born to women with placental abruption. Results of the random effects meta-analysis show that the odds of infants born to pregnant women with placental abruption who experience cerebral palsy is higher than in infants born to pregnant women without placental abruption (OR 5.71 95% CI (1.17, 27.91); I2 = 84.0%). There is no statistical difference in the odds of infants born to pregnant women with placental abruption who experience severe IVH (grade 3+) (OR 1.20 95% CI (0.46, 3.11); I2 = 35.8%) and any grade of IVH (OR 1.20 95% CI (0.62, 2.32); I2 = 32.3%) vs. women without placental abruption. There is no statistically significant difference in the odds of infants born to pregnant women with placental abruption who experience PVL vs. pregnant women without placental abruption (OR 6.51 95% CI (0.94, 45.16); I2 = 0.0%). Despite our meta-analysis suggesting increased odds of cerebral palsy in infants born to pregnant women with placental abruption versus without abruption, this finding should be interpreted cautiously, given high heterogeneity and overall poor quality of the included studies.
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Affiliation(s)
- Irina Oltean
- Department of Surgery & Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada; (I.O.); (K.T.)
| | - Ajay Rajaram
- Department of Pathology, McGill University, Montreal, QC H4A 3J1, Canada;
| | - Ken Tang
- Department of Surgery & Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada; (I.O.); (K.T.)
| | - James MacPherson
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (J.M.); (Y.N.)
| | | | - Aanchal Rishi
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada;
| | - Regan Toltesi
- Faculty of Science, Engineering and Architecture, Laurentian University, Sudbury, ON P3E 2C6, Canada;
| | - Rachel Gowans
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Ashkan Jahangirnia
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (A.J.); (S.L.L.)
| | - Youssef Nasr
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (J.M.); (Y.N.)
| | - Sarah L. Lawrence
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (A.J.); (S.L.L.)
- Division of Neonatology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Dina El Demellawy
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (A.J.); (S.L.L.)
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
- Correspondence: ; Tel.: +1-613-737-7600
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Shi Z, Luo K, Jani S, February M, Fernandes N, Venkatesh N, Sharif N, Tan S. Mimicking partial to total placental insufficiency in a rabbit model of cerebral palsy. J Neurosci Res 2022; 100:2138-2153. [PMID: 34173261 PMCID: PMC8709884 DOI: 10.1002/jnr.24901] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 01/07/2023]
Abstract
All placental abruptions begin as partial abruptions, which sometimes manifest as fetal bradycardia. The progression from partial to total abruption was mimicked by a new rabbit model of placental insufficiency, and we compared it, with sufficient statistical power, with the previous model mimicking total placental abruption. The previous model uses total uterine ischemia at E22 or E25 (70% or 79% term, respectively), in pregnant New Zealand white rabbits for 40 min (Full H-I). The new model, Partial+Full H-I, added a 30-min partial ischemia before the 40-min total ischemia. Fetuses were delivered either at E31.5 (full term) vaginally for neurobehavior testing, or by C-section at E25 for ex vivo brain cell viability evaluation. The onset of fetal bradycardia was within the first 2 min of either H-I protocol. There was no difference between Full H-I (n = 442 for E22, 312 for E25) and Partial+Full H-I (n = 154 and 80) groups in death or severely affected kits at E22 (76% vs. 79%) or at E25 (66% vs. 64%), or normal kits at E22 or E25, or any of the individual newborn neurobehavioral tests at any age. No sex differences were found. Partial+Full H-I (n = 6) showed less cell viability than Full H-I (n = 8) at 72-hr ex vivo in the brain regions studied. Partial+Full H-I insult produced similar cerebral palsy phenotype as our previous Full H-I model in a sufficiently powered study and may be more suitable for testing of potential neuroprotectants.
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Affiliation(s)
- Zhongjie Shi
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI
| | - Kehuan Luo
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI
| | - Sanket Jani
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI
| | - Melissa February
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI
| | - Nithi Fernandes
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI
| | | | | | - Sidhartha Tan
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI
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Hasegawa J, Nakao M, Ikeda T, Toyokawa S, Jojima E, Satoh S, Ichizuka K, Tamiya N, Nakai A, Fujimori K, Maeda T, Takeda S, Suzuki H, Ueda S, Iwashita M, Ikenoue T. Fetal heart rate evolution patterns in cerebral palsy associated with umbilical cord complications: a nationwide study. BMC Pregnancy Childbirth 2022; 22:177. [PMID: 35241026 PMCID: PMC8896380 DOI: 10.1186/s12884-022-04508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background The aim of the present study was to clarify fetal heart rate (FHR) evolution patterns in infants with cerebral palsy (CP) according to different types of umbilical cord complications. Methods This case–control study included children born: with a birth weight ≥2000 g, at gestational age ≥33 weeks, with disability due to CP, and between 2009 and 2014. Obstetric characteristics and FHR patterns were compared among patients with CP associated with (126 cases) and without (594 controls) umbilical cord complications. Results There were 32 umbilical cord prolapse cases and 94 cases with coexistent antenatal umbilical cord complications. Compared with the control group, the persistent non-reassuring pattern was more frequent in cases with coexistent antenatal umbilical cord complications (p = 0.012). A reassuring FHR pattern was observed on admission, but resulted in prolonged deceleration, especially during the first stage of labor, and was significantly identified in 69% of cases with umbilical cord prolapse and 35% of cases with antenatal cord complications, compared to 17% of control cases (p < 0.001). Conclusion Hypercoiled cord and abnormal placental umbilical cord insertion, may be associated with CP due to acute hypoxic-ischemic injury as well as sub-acute or chronic adverse events during pregnancy, while umbilical cord prolapse may be characterized by acute hypoxic-ischemic injury during delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04508-2.
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Affiliation(s)
- Junichi Hasegawa
- Visiting Researcher, Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan. .,Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Masahiro Nakao
- Visiting Researcher, Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan.,Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan.,The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan
| | - Satoshi Toyokawa
- Visiting Researcher, Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Public Health, The University of Tokyo, Tokyo, Japan
| | - Emi Jojima
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shoji Satoh
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan
| | - Kiyotake Ichizuka
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Nanako Tamiya
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihito Nakai
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Keiya Fujimori
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Tsugio Maeda
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Maeda Clinic, Incorporated Association Anzu-kai, Shizuoka, Japan
| | - Satoru Takeda
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hideaki Suzuki
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shigeru Ueda
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Mitsutoshi Iwashita
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Kugayama Hospital, Tokyo, Japan
| | - Tsuyomu Ikenoue
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Miyazaki University, Miyazaki, Japan
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Moriwaki M, Yuasa H, Kakehashi M, Suzuki H, Kobayashi Y. Impact of social support for mothers as caregivers of cerebral palsy children in Japan. J Pediatr Nurs 2022; 63:e64-e71. [PMID: 34736819 DOI: 10.1016/j.pedn.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/15/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Social supports are critical to alleviate the psychological and physical burden of primary caregivers of children with disabilities. This study aims to (1) clarify how cerebral palsy in children affects caregiving burden of the mother, and (2) identify the social supports that can effectively reduce that burden. DESIGN AND METHODS This is a cross-sectional study in which mothers of children with cerebral palsy completed questionnaires and provided data regarding their child's condition, family support, social support usage, degree of satisfaction with supports, and caregiving burden. RESULTS We analyzed responses from 1190 mothers. Support usage, particularly of home-visit nursing, home care, home-visit rehabilitation, and mobility support, was higher in severely burdened groups. However, the proportion of satisfaction with social support in groups with light or no burden were higher, particularly in home care, home-visit rehabilitation, training/treatment, and short stays. Mothers whose children have an intellectual disability and gross exercise ≥1 in addition to tube feeding or intravenous nutrition especially felt a strong sense of burden. The most effective measure in reducing mother's sense of burden was short stays. CONCLUSIONS Mothers with children who can move and have an intellectual disability felt more burden compared with mothers of bedridden children. The findings clarify that supports, such as home care and short stays, have a significant impact on reducing the mother's sense of burden. PRACTICE IMPLICATIONS Due to the large sample size, we believe that the results can inform efforts to increase social support for caregivers.
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Affiliation(s)
- Mutsuko Moriwaki
- Quality Management Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Hitomi Yuasa
- Japan Council for Quality Health Care, 1-4-17, Toyo Bldg., Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan.
| | - Masayuki Kakehashi
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8553, Japan.
| | - Hideaki Suzuki
- Japan Council for Quality Health Care, 1-4-17, Toyo Bldg., Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan.
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-17 0033, Japan.
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9
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Cerebral palsy and the placenta: A review of the maternal-placental-fetal origins of cerebral palsy. Exp Neurol 2022; 352:114021. [DOI: 10.1016/j.expneurol.2022.114021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/30/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
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10
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Nakao M, Nanba Y, Okumura A, Hasegawa J, Toyokawa S, Ichizuka K, Kanayama N, Satoh S, Tamiya N, Nakai A, Fujimori K, Maeda T, Suzuki H, Iwashita M, Oka A, Ikeda T. Correlation between fetal heart rate evolution patterns and magnetic resonance imaging findings in severe cerebral palsy: A longitudinal study. BJOG 2022; 129:1574-1582. [PMID: 35007405 PMCID: PMC9545186 DOI: 10.1111/1471-0528.17089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate the association between hypoxic-ischaemic insult timing and brain injury type in infants with severe cerebral palsy (CP). DESIGN Longitudinal study. SETTING Database of the Recurrence Prevention Committee, Japan Obstetric Compensation System for Cerebral Palsy. SAMPLE Infants with severe CP born at ≥34 weeks of gestation. METHODS The intrapartum fetal heart rate (FHR) strips were categorised as continuous bradycardia; persistently non-reassuring (NR-NR); reassuring-prolonged deceleration (R-PD); Hon's pattern (R-Hon); persistently reassuring (R-R); and unclassified. The brain magnetic resonance imaging (MRI) scans were categorised based on the predominant site involved: basal ganglia-thalamus (BGT); white matter (WM); watershed (WS); stroke; normal; and unclassified. MAIN OUTCOME MEASURES Manifestations of the brain MRI types and the association between FHR evolution pattern and MRI type were analysed. RESULTS Among 672 eligible infants, 76% had BGT-dominant injury, 5.4% WM, 1.2% WS, 1.6% stroke, 1.9% normal, and 14% unclassified. Placental abruption and small-for-gestational age were associated with an increased (adjusted odds ratio [aOR] 8.02) and decreased (aOR 0.38) risk of BGT injury, respectively. The majority of infants had BGT injury in most FHR groups (bradycardia, 97%; NR-NR, 75%; R-PD, 90%; R-Hon, 76%; and R-R, 45%). The risk profiles in case of BGT in the NR-NR group were similar to those in the R-PD and R-Hon groups. CONCLUSION BGT-dominant brain damage accounted for three-fourths of the cases of CP in term or near-term infants, even in prenatal onset cases. Hypoxic-ischaemic insult has a major impact on CP development during the antenatal period.
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Affiliation(s)
- Masahiro Nakao
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynaecology, Mie University Graduate School of Medicine, Tsu, Japan.,Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Yukiko Nanba
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Paediatrics, National Rehabilitation Center for Children with Disabilities, Tokyo, Japan
| | - Asumi Okumura
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynaecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Junichi Hasegawa
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynaecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Satoshi Toyokawa
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyotake Ichizuka
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynaecology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Naohiro Kanayama
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynaecology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Shoji Satoh
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Maternal and Perinatal Care Centre, Oita Prefectural Hospital, Oita, Japan
| | - Nanako Tamiya
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihito Nakai
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynaecology, Nippon Medical School, Tokyo, Japan
| | - Keiya Fujimori
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynaecology, Fukushima Medical University, Fukushima, Japan
| | - Tsugio Maeda
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Maeda Clinic, Incorporated Association Anzu-kai, Shizuoka, Japan
| | - Hideaki Suzuki
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Mitsutoshi Iwashita
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Kugayama Hospital, Tokyo, Japan
| | - Akira Oka
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Paediatrics, Saitama Children's Medical Centre, Saitama, Japan
| | - Tomoaki Ikeda
- The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynaecology, Mie University Graduate School of Medicine, Tsu, Japan
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11
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Suzuki S. Placental abruption associated with cerebral palsy. J NIPPON MED SCH 2022; 89:263-268. [DOI: 10.1272/jnms.jnms.2022_89-312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics & Gynecology, Nippon Medical School
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12
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Paprocka J, Kaminiów K, Kozak S, Sztuba K, Emich-Widera E. Stem Cell Therapies for Cerebral Palsy and Autism Spectrum Disorder-A Systematic Review. Brain Sci 2021; 11:1606. [PMID: 34942908 PMCID: PMC8699362 DOI: 10.3390/brainsci11121606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/27/2021] [Accepted: 12/01/2021] [Indexed: 12/05/2022] Open
Abstract
Autism spectrum disorder (ASD) and cerebral palsy (CP) are some of the most common neurodevelopmental diseases. They have multifactorial origin, which means that each case may manifest differently from the others. In patients with ASD, symptoms associated with deficits in social communication and characteristic, repetitive types of behaviors or interests are predominant, while in patients with CP, motor disability is diagnosed with accompanying cognitive impairment of various degrees. In order to minimize their adverse effects, it is necessary to promptly diagnose and incorporate appropriate management, which can significantly improve patient quality of life. One of the therapeutic possibilities is stem cell therapy, already known from other branches of medicine, with high hopes for safe and effective treatment of these diseases. Undoubtedly, in the future we will have to face the challenges that will arise due to the still existing gaps in knowledge and the heterogeneity of this group of patients. The purpose of this systematic review is to summarize briefly the latest achievements and advances in stem cell therapy for ASD and CP.
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Affiliation(s)
- Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Konrad Kaminiów
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (K.K.); (S.K.); (K.S.)
| | - Sylwia Kozak
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (K.K.); (S.K.); (K.S.)
| | - Karolina Sztuba
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (K.K.); (S.K.); (K.S.)
| | - Ewa Emich-Widera
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
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13
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Nakao M, Okumura A, Hasegawa J, Toyokawa S, Ichizuka K, Kanayama N, Satoh S, Tamiya N, Nakai A, Fujimori K, Maeda T, Suzuki H, Iwashita M, Ikeda T. Fetal heart rate pattern in term or near-term cerebral palsy: a nationwide cohort study. Am J Obstet Gynecol 2020; 223:907.e1-907.e13. [PMID: 32497609 DOI: 10.1016/j.ajog.2020.05.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is crucial to interpret fetal heart rate patterns with a focus on the pattern evolution during labor to estimate the relationship between cerebral palsy and delivery. However, nationwide data are not available. OBJECTIVE The aim of our study was to demonstrate the features of fetal heart rate pattern evolution and estimate the timing of fetal brain injury during labor in cerebral palsy cases. STUDY DESIGN In this longitudinal study, 1069 consecutive intrapartum fetal heart rate strips from infants with severe cerebral palsy at or beyond 34 weeks of gestation, were analyzed. They were categorized as follows: (1) continuous bradycardia (Bradycardia), (2) persistently nonreassuring, (3) reassuring-prolonged deceleration, (4) Hon's pattern, and (5) persistently reassuring. The clinical factors underlying cerebral palsy in each group were assessed. RESULTS Hypoxic brain injury during labor (those in the reassuring-prolonged deceleration and Hon's pattern groups) accounted for 31.5% of severe cerebral palsy cases and at least 30% of those developed during the antenatal period. Of the 1069 cases, 7.86% were classified as continuous bradycardia (n=84), 21.7% as persistently nonreassuring (n=232), 15.6% as reassuring-prolonged deceleration (n=167), 15.9% as Hon's pattern (n=170), 19.8% as persistently reassuring (n=212), and 19.1% were unclassified (n=204). The overall interobserver agreement was moderate (kappa 0.59). Placental abruption was the most common cause (31.9%) of cerebral palsy, accounting for almost 90% of cases in the continuous bradycardia group (64 of 73). Among the cases in the Hon's pattern group (n=67), umbilical cord abnormalities were the most common clinical factor for cerebral palsy development (29.9%), followed by placental abruption (20.9%), and inappropriate operative vaginal delivery (13.4%). CONCLUSION Intrapartum hypoxic brain injury accounted for approximately 30% of severe cerebral palsy cases, whereas a substantial proportion of the cases were suspected to have either a prenatal or postnatal onset. Up to 16% of cerebral palsy cases may be preventable by placing a greater focus on the earlier changes seen in the Hon's fetal heart rate progression.
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Affiliation(s)
- Masahiro Nakao
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan; Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan.
| | - Asumi Okumura
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan; Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan
| | - Junichi Hasegawa
- Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Satoshi Toyokawa
- Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Public Health, the University of Tokyo, Tokyo, Japan
| | - Kiyotake Ichizuka
- Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Naohiro Kanayama
- Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Shoji Satoh
- Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan
| | - Nanako Tamiya
- Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihito Nakai
- Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Keiya Fujimori
- Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Tsugio Maeda
- Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Maeda Clinic, Incorporated Association Anzu-kai, Shizuoka, Japan
| | - Hideaki Suzuki
- Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan
| | - Mitsutoshi Iwashita
- Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomoaki Ikeda
- Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan
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Yasuaki K, Mizue T, Akimichi S, Yoshio S. Current Status of the Obstetric Compensation System for Cases of Cerebral Palsy at a General Hospital in Tochigi, Japan. Glob Pediatr Health 2020; 7:2333794X20973845. [PMID: 33241087 PMCID: PMC7672716 DOI: 10.1177/2333794x20973845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022] Open
Abstract
Objective. The Japan Obstetric Compensation System for Cerebral Palsy (JOCSC) was launched in January 2009 as the first nationwide nofault compensation system. The aim of the study was to clarify the present status of functioning of the JOCSC in pediatric and obstetric departments at a general hospital. Method. Children eligible for compensation are as follows: (1) Gestational week at 32 weeks or later and birth weight of 1400 g or more, or 28 weeks or later with apparent asphyxia at birth. (2) Severe cerebral palsy related to hypoxia at delivery, not caused by congenital reasons or factors during the neonatal period. Results. Applications for the JOCSC were submitted for 11 cases (5 cases born at our hospital and 6 cases born at other childbirth facilities). Eight cases (4 cases born at our hospital and 4 cases born at other childbirth facilities) were authorized for the JOCSC. Remaining 3 cases were judged as not being eligible because of 2 cases with congenital reasons for the condition and 1 case with the judgement as mild cerebral palsy. Conclusion. Ten years have elapsed since the establishment of the JOCSC. Improved awareness of the medical staff and caregivers of children with cerebral palsy about the JOCSC should be promoted.
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Affiliation(s)
| | - Tsukui Mizue
- Japanese Red Cross Ashikaga Hospital, Ashikaga City, Tochigi, Japan
| | - Shibata Akimichi
- Japanese Red Cross Ashikaga Hospital, Ashikaga City, Tochigi, Japan
| | - Suda Yoshio
- Japanese Red Cross Ashikaga Hospital, Ashikaga City, Tochigi, Japan
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Toyokawa S, Hasegawa J, Ikenoue T, Asano Y, Jojima E, Satoh S, Ikeda T, Ichizuka K, Takeda S, Tamiya N, Nakai A, Fujimori K, Maeda T, Masuzaki H, Suzuki H, Ueda S. Weekend and off-hour effects on the incidence of cerebral palsy: contribution of consolidated perinatal care. Environ Health Prev Med 2020; 25:52. [PMID: 32912144 PMCID: PMC7488476 DOI: 10.1186/s12199-020-00889-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022] Open
Abstract
Objective This study estimated the effects of weekend and off-hour childbirth and the size of perinatal medical care center on the incidence of cerebral palsy. Methods The cases were all children with severe cerebral palsy born in Japan from 2009 to 2012 whose data were stored at the Japan Obstetric Compensation System for Cerebral Palsy database, a nationally representative database. The inclusion criteria were the following: neonates born between January 2009 and December 2012 who had a birth weight of at least 2000 g and gestational age of at least 33 weeks and who had severe disability resulting from cerebral palsy independent of congenital causes or factors during the neonatal period or thereafter. Study participants were restricted to singletons and controls without report of death, scheduled cesarean section, or ambulance transportation. The controls were newborns, randomly selected by year and type of delivery (normal spontaneous delivery without cesarean section and emergency cesarean section) using a 1:10 case to control ratio sampled from the nationwide Japan Society of Obstetrics and Gynecology database. Results A total of 90 cerebral palsy cases and 900 controls having normal spontaneous delivery without cesarean section were selected, as were 92 cerebral palsy cases and 920 controls with emergent cesarean section. A significantly higher risk for cerebral palsy was found among cases that underwent emergent cesarean section on weekends (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.06–2.81) and during the night shift (OR 2.29, 95% CI 1.30–4.02). No significant risk was found among normal spontaneous deliveries on weekends (OR 1.63, 95% CI 0.97–2.73) or during the quasi-night shift (OR 1.26, 95% CI 0.70–2.27). Regional perinatal care centers showed significantly higher risk for cerebral palsy in both emergent cesarean section (OR 2.35, 95% CI 1.47–3.77) and normal spontaneous delivery (OR 2.92, 95% CI 1.76–4.84). Conclusion Labor on weekends, during the night shift, and at regional perinatal medical care centers was associated with significantly elevated risk for cerebral palsy in emergency cesarean section.
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Affiliation(s)
- Satoshi Toyokawa
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.
| | - Junichi Hasegawa
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Yuri Asano
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Emi Jojima
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shoji Satoh
- Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kiyotake Ichizuka
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihito Nakai
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | | | - Hideaki Masuzaki
- Department of Obstetrics and Gynecology, University of Nagasaki, Nagasaki, Japan
| | - Hideaki Suzuki
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shigeru Ueda
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
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16
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Naruse K, Shigemi D, Hashiguchi M, Imamura M, Yasunaga H, Arai T, Yasuhi I, Ozaki Y, Sakajo A, Tajima A, Tsutsumi S, Nakayama S, Yamasaki T, Nakago S, Hiramatsu Y, Mochizuki J, Hashiguchi M, Naruse K, Arai T. Placental abruption in each hypertensive disorders of pregnancy phenotype: a retrospective cohort study using a national inpatient database in Japan. Hypertens Res 2020; 44:232-238. [DOI: 10.1038/s41440-020-00537-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/16/2020] [Accepted: 07/25/2020] [Indexed: 02/02/2023]
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17
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Ichizuka K, Toyokawa S, Ikenoue T, Satoh S, Hasegawa J, Ikeda T, Tamiya N, Nakai A, Fujimori K, Maeda T, Kanayama N, Masuzaki H, Iwashita M, Suzuki H, Takeda S. Risk factors for cerebral palsy in neonates due to placental abruption. J Obstet Gynaecol Res 2020; 47:159-166. [PMID: 32885550 PMCID: PMC7818445 DOI: 10.1111/jog.14447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/14/2020] [Accepted: 08/02/2020] [Indexed: 11/28/2022]
Abstract
Aim This study aimed to identify risk factors for the onset of cerebral palsy (CP) in neonates due to placental abruption and investigate their characteristics. Methods A retrospective case–control study was conducted using a nationwide registry from Japan. The study population included pregnant women (n = 122) who delivered an infant with CP between 2009 and 2015, where placental abruption was identified as the single cause of CP. The control group consisted of pregnant women with placental abruption, who delivered an infant without CP and were managed from 2013 to 2014. They were randomly identified from the prenatal database of the Japan Society of Obstetrics and Gynecology (JSOG‐DB; n = 1214). Risk factors were investigated using multivariate analysis. Results Alcohol consumption (3.38, 2.01–5.68) (odds ratio, 95% confidence interval), smoking during pregnancy (3.50, 1.32–9.25), number of deliveries (1.28, 1.05–1.56), polyhydramnios (5.60, 1.37–22.6), oral administration of ritodrine hydrochloride (2.09, 1.22–3.57) and hypertensive disorders in pregnancy (2.25, 1.27–4.07) were significant risk factors. In contrast, intravenous administration of oxytocin (odds ratio, 95% confidence interval: 0.22, 0.09–0.58) and magnesium sulfate (0.122, 0.02–0.89) attenuated risk. Conclusion Alcohol consumption, smoking during pregnancy, number of deliveries, polyhydramnios, oral administration of ritodrine hydrochloride and hypertensive disorders in pregnancy were identified as risk factors for CP following placental abruption. Regarding alcohol consumption and smoking during pregnancy, the results suggest the importance of educational activities targeting pregnant women to increase their awareness of placental abruption.
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Affiliation(s)
- Kiyotake Ichizuka
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Satoshi Toyokawa
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tsuyomu Ikenoue
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, Faculty of Medicine, Miyazaki University, Miyazaki, Japan
| | - Shoji Satoh
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics, Oita Prefectural Hospital, Oita, Japan
| | - Junichi Hasegawa
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, Saint Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoaki Ikeda
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, Mie University, Tsu, Japan
| | - Nanako Tamiya
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, Tsukuba University, Tsukuba, Japan
| | - Akihito Nakai
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, Nippon Medical University, Tokyo, Japan
| | - Keiya Fujimori
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Tsugio Maeda
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Maeda Obstetrics and Gynecology Clinic, Yaizu, Japan
| | - Naohiro Kanayama
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideaki Masuzaki
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, Nagasaki University, Nagasaki, Japan
| | - Mitsutoshi Iwashita
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Kugayama Hospital, Tokyo, Japan
| | - Hideaki Suzuki
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan
| | - Satoru Takeda
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan
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Hasegawa J, Sekizawa A, Arakaki T, Ikeda T, Ishiwata I, Kinoshita K. Declined use of cervical ripening balloon did not reduce the incidence of umbilical cord prolapse in Japan. J Obstet Gynaecol Res 2020; 46:1349-1354. [PMID: 32557956 DOI: 10.1111/jog.14317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/13/2020] [Accepted: 05/07/2020] [Indexed: 11/28/2022]
Abstract
AIM To clarify whether the incidence of umbilical cord prolapse (UCP) at delivery is related to the cervical ripening balloon (CRB). METHODS A postal questionnaire study was conducted in 2018 in institutions providing maternity services across Japan. Questions on the number of deliveries, labor inductions, used CRB and cases of UCP in 2017 were included. Because a similar questionnaire survey was conducted in 2012, the incidence of UCP and frequency of the use of CRB were compared. RESULTS A total of 1354 answers were assessed (57% of all delivery institutions). The total number of deliveries was 490 279. Of these, 78% were transvaginal; 74 cases of UCP were reported (0.015%), while 13 cases were reported from obstetric facilities never using CRB (0.008%). The incidence of UCP (odds ratio [95% confidence interval]) was 0.036% in the intracervical type (4.3 [1.6-11.3]), 0.091% in the disk-type (11.0 [4.2-29.0]) and 0.067% in the ball-type (8.1 [2.8-22.8]). Frequencies of the use of CRB were 7.3% and 6.6% in the 2012 and 2018 surveys, respectively. The use of the intracervical type increased from 2.8% in the 2012 survey to 3.5% in the 2018 survey, while that of the disk-type and ball-type declined. However, the incidence of UCP was not different between the two surveys regardless of the use of cervical ripening balloons (0.014% vs 0.015% with CRB, 0.005% vs 0.008% without CRB). CONCLUSION Although the frequency of CRB use significantly declined, the incidence of UCP did not significantly reduce in the last 5 years.
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Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Mito, Japan
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19
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Hasegawa J, Sekizawa A, Arakaki T, Ikeda T, Ishiwata I, Kinoshita K. Decline number of uterine fundal pressure maneuver in Japan recent 5 years. J Obstet Gynaecol Res 2020; 46:413-417. [PMID: 31955474 DOI: 10.1111/jog.14203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/31/2019] [Indexed: 11/29/2022]
Abstract
AIM To clarify whether the incidence of uterine fundal pressure (UFP) maneuver at delivery and consequent uterine rupture were declined. METHODS Population-based postal questionnaire study was conducted. A questionnaire was sent to obstetric institutions across Japan. Questions were included the total number of deliveries, UFP and uterine ruptures associated with UFP in 2012 and 2017. As the primary outcome, frequencies of the UFP and uterine rupture were compared between 2012 and 2017. The secondary outcomes were included improved managements of delivery regarding UFP. RESULTS A number of vaginal deliveries were significantly declined from 80.4% in 2012 to 78.1% in 2017 (P < 0.001). Frequencies of UFP per vaginal deliveries were also significantly declined 11.2% (38 973/347771) in 2012 to 9.5% (35 205/404444) in 2017 (<0.001). Number of uterine ruptures were 6 cases in 2012 (1:6496) and 11 cases in 2017 (1:3473) (P = 0.210). Compared to situation in 2012, informed consent was more frequently obtained for UFP in 2017. Written informed consent for UFP became to be obtained in 12% of institutions in 2017 from only 3% in 2012. More than 80% of institutions are performing UFP within 3 times. Regarding to uterine rupture, try of labor after the cesarean section, UFP and augmentation were improved in more than 10% of institutions. Most impact vehicle changing behavior was OBGY clinical guideline. CONCLUSION Although significant declined incidence of uterine rupture after UFP could not be demonstrated, frequency of UFP was decreased recent 5 years. This is due to improvement of obstetric management by obstetric caregivers throughout Japan.
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Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
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20
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Mutoh T, Mutoh T, Tsubone H, Takada M, Doumura M, Ihara M, Shimomura H, Taki Y, Ihara M. Impact of Long-Term Hippotherapy on the Walking Ability of Children With Cerebral Palsy and Quality of Life of Their Caregivers. Front Neurol 2019; 10:834. [PMID: 31456733 PMCID: PMC6701452 DOI: 10.3389/fneur.2019.00834] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Cerebral palsy (CP) is a permanent motor disorder that occurs at birth or during early infancy. Despite advances in fetal and maternal medicine, the incidence of CP remains high. Hippotherapy has gradually been recognized as an excellent rehabilitation tool for children with CP. However, a scientific basis for how it achieves long-term functional improvements or provides additional benefits to patients' caregivers remains unknown. Objectives: We performed a prospective trial to determine how hippotherapy affects the gross motor and gait functions in children with CP and how it may also impact the quality of life (QOL) of patients' caregivers. Methods: In total, 24 children with CP (11 boys, 13 girls; age: 4-14 years; Gross Motor Function Classification System [GMFCS] II-III) underwent a program (30 min/day, once a week) of hippotherapy or day-care recreation (control) over a 1-year intervention and a 3-month follow-up period. Assessment measures used for the children were gait parameters for a 5-m walk test, Gross Motor Function Measure (GMFM)-66, and GMFM dimension-E (GMFM-E). The QOL of the caregivers was estimated using a brief version of the World Health Organization Quality Of Life (WHOQOL-BREF) self-assessment questionnaire. Results: In addition to better GMFM-66 and GMFM-E scores, hippotherapy was associated with increased cadence, step length, and mean acceleration; stabilized horizontal/vertical displacement of patients; and better relationship between the psychological status and QOL of the caregivers than those seen in the control group (p < 0.05). Additionally, the initially improved children's step length and their caregivers' psychological QOL domain (particularly in the "positive feeling" facet) tended to be preserved up to the 3-month follow-up. Conclusion: These data suggest that compared with common day-care recreational activities, a 1-year program of once-weekly hippotherapy can improve not only the walking ability of children with CP but also the psychological health and QOL of their caregivers. Clinical Trial Registration:: www.umin.ac.jp/ctr/, identifier: UMIN000022986.
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Affiliation(s)
- Tomoko Mutoh
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.,Division of Clinical Psychology, Graduate School of Human Sciences, Kobe Shoin Women's University, Kobe, Japan
| | - Tatsushi Mutoh
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Hirokazu Tsubone
- Department of Veterinary Medical Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | | | - Misato Doumura
- Holistic Betterment and Wellness Through Riding PIROUETTE, Utsunomiya, Japan
| | - Masayo Ihara
- Holistic Betterment and Wellness Through Riding PIROUETTE, Utsunomiya, Japan
| | - Hideo Shimomura
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Yasuyuki Taki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Masahiro Ihara
- Faculty of Medical Technology, Teikyo University, Utsunomiya, Japan
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21
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Management of disseminated intravascular coagulation associated with placental abruption and measures to improve outcomes. Obstet Gynecol Sci 2019; 62:299-306. [PMID: 31538072 PMCID: PMC6737058 DOI: 10.5468/ogs.2019.62.5.299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/26/2019] [Accepted: 04/17/2019] [Indexed: 11/08/2022] Open
Abstract
Placental abruption is a condition that should be carefully considered in perinatal management because it is associated with serious events in both the mother and neonate, such as intrauterine fetal death, cerebral palsy, obstetric critical bleeding, and uncontrollable bleeding. The concomitant presence of disseminated intravascular coagulation (DIC) more easily causes critical bleeding that may necessitate hysterectomy or multi-organ failure resulting in maternal death. Therefore, early management should be provided to prevent progression to serious conditions by performing both hemostatic procedures and DIC treatment. To take measures to improve the outcomes in both the mother and neonate, health guidance for pregnant women, early diagnosis, early treatment, development of the emergency care system, and provision of a system for transport to higher-level medical institutions should be implemented.
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22
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Hasegawa J, Ikeda T, Toyokawa S, Jojima E, Satoh S, Ichizuka K, Tamiya N, Nakai A, Fujimori K, Maeda T, Takeda S, Suzuki H, Ueda S, Iwashita M, Ikenoue T. Obstetric factors associated with uterine rupture in mothers who deliver infants with cerebral palsy. J Matern Fetal Neonatal Med 2019; 34:663-669. [PMID: 31032674 DOI: 10.1080/14767058.2019.1611775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The aim of the present study was to clarify the obstetric factors associated with uterine rupture in mothers who deliver infants with cerebral palsy (CP) in Japan.Methods: This retrospective case-cohort study reviewed the obstetric characteristics and clinical courses of mothers who experienced uterine rupture and compared those who delivered an infant with CP (cases) with those who delivered an infant without CP (cohort). Data were obtained from the Japan Obstetric Compensation System for CP database (27 cases) and the perinatal database of the Japan Society of Obstetrics and Gynecology (312 cohorts). The subjects included live singleton infants delivered between 2009 and 2014 with a birth weight ≥2000 g and gestation ≥33 weeks.Results: Augmentation was performed 33% in cases and 8% in cohorts (p < .001). The amount of bleeding during surgery was 1819 g in cases and 1096 g in cohorts (p < .001). Length of gestational weeks and neonatal birth weight were significantly higher and Apgar scores and umbilical arterial pH were lower in cases compared to cohorts (p < .001). In cases with CP, 11 cases of uterine rupture involved scarred uteruses. Seven were trial of labor after a previous cesarean. On one hand, 16 cases occurred in unscarred uteruses. Five of the uterine fundal pressure maneuvers and four of tachysystole due to excessive augmentation were reported in association with uterine rupture.Conclusion: Two-third of the relevant obstetric factors for CP associated with uterine rupture were iatrogenic. At least, to reduce CP resulting from delivery-related uterine rupture, reckless delivery management should be avoided.
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Affiliation(s)
- Junichi Hasegawa
- Visiting Researcher, Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, St Marianna University School of Medicine, Kanagawa, Japan
| | - Tomoaki Ikeda
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan
| | - Satoshi Toyokawa
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Department of Public Health, The University of Tokyo, Tokyo, Japan
| | - Emi Jojima
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shoji Satoh
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan
| | - Kiyotake Ichizuka
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Nanako Tamiya
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihito Nakai
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Keiya Fujimori
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Tsugio Maeda
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Maeda Clinic, Incorporated Association Anzu-kai, Shizuoka, Japan
| | - Satoru Takeda
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hideaki Suzuki
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shigeru Ueda
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan
| | - Mitsutoshi Iwashita
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Kugayama Hospital, Tokyo, Japan
| | - Tsuyomu Ikenoue
- The Prevention Recurrence Committee, Mie Japan Obstetric Compensation System for Cerebral Palsy, Japan.,Miyazaki University, Miyazaki, Japan
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23
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Suzuki S, Shibata Y. Trends in obstetric policies in cases of failed vacuum extraction in Japan. J Matern Fetal Neonatal Med 2019; 34:614-617. [PMID: 31017027 DOI: 10.1080/14767058.2019.1611767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: In April 2008, the guidelines for obstetric practice in Japan have made the following recommendations: (1) do not use vacuum extraction (VE) for more than 20 min, and consider forceps delivery (FD) or an emergency cesarean section (CS) if necessary (20-minute VE trial rule), and (2) do not try VE more than five times, even if VE has been used for less than 20 min (5-time VE trial rule). The aims of the present study were to compare the obstetric policies related to failed VE before and after 2008.Methods: We reviewed the obstetric records of all cases of VE in cases of singleton pregnancy with a neonatal birth weight ≥ 2500 g beyond 37 weeks' gestation at our hospital from April 2002 to March 2014.Results: The success rate of VE decreased significantly (96.8 versus 94.1%, p = .02), while the rate of CS increased significantly (2.2 versus 5.0%, p < .01); however, there were no significant differences in these values between the two periods.Conclusions: We could not find the effects of the recommendation limiting the practice of VE.
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Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan
| | - Yoshie Shibata
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan
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24
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Huang L, Zhang C, Gu J, Wu W, Shen Z, Zhou X, Lu H. A Randomized, Placebo-Controlled Trial of Human Umbilical Cord Blood Mesenchymal Stem Cell Infusion for Children With Cerebral Palsy. Cell Transplant 2019; 27:325-334. [PMID: 29637820 PMCID: PMC5898688 DOI: 10.1177/0963689717729379] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cerebral palsy (CP) is a common disability which results in permanent chronic motor disability appearing in early childhood. Recently human umbilical cord blood mesenchymal stem cell (hUCB-MSC) infusion has emerged as a promising therapeutic strategy for CP, and the treatment efficacy remains to be confirmed by clinical trials. All 54 patients received basic rehabilitation as a background treatment. The infusion group comprising 27 patients received 4 infusions of hUCB-MSCs (intravenous infusions at a fixed dose of 5 × 107) and basic rehabilitation treatment, whereas 27 patients in the control group received 0.9% normal saline and basic rehabilitation treatment. Several indices were tested from baseline up to 24 months posttreatment regarding efficacy and safety evaluations, including the gross motor function measurement 88 (GMFM-88) scores, the comprehensive function assessment (CFA), lab tests, electroencephalogram (EEG), routine magnetic resonance imaging (MRI), and adverse events. The changes in the total proportion of GMFM-88 and total scores of CFA in the hUCB-MSC infusion group were significantly higher than that in control group at 3, 6, 12, 24 months posttreatment. Less diffuse slow waves were noticed after hUCB-MSC infusion in patients with slowing of EEG background rhythms at baseline. Based on the routine MRI exams, improvements in cerebral structures were rare after treatment. Serious adverse events were not observed during the whole study period. The results of the study indicated that hUCB-MSC infusion with basic rehabilitation was safe and effective in improving gross motor and comprehensive functions in children with CP.
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Affiliation(s)
- Li Huang
- 1 Institute of Neurobiology and Department of Human Anatomy & Histoembriology, School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, Shanxi, People Republic of China.,2 Taihe Hospital Affiliated to Hubei Medical College, Shiyan, Hubei, People Republic of China
| | - Che Zhang
- 2 Taihe Hospital Affiliated to Hubei Medical College, Shiyan, Hubei, People Republic of China.,3 Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, People Republic of China
| | - Jiaowei Gu
- 2 Taihe Hospital Affiliated to Hubei Medical College, Shiyan, Hubei, People Republic of China
| | - Wei Wu
- 2 Taihe Hospital Affiliated to Hubei Medical College, Shiyan, Hubei, People Republic of China
| | - Zhujun Shen
- 2 Taihe Hospital Affiliated to Hubei Medical College, Shiyan, Hubei, People Republic of China
| | - Xihui Zhou
- 3 Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, People Republic of China
| | - Haixia Lu
- 1 Institute of Neurobiology and Department of Human Anatomy & Histoembriology, School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, Shanxi, People Republic of China
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25
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Ushiro S, Suzuki H, Ueda S. Japan Obstetric Compensation System for Cerebral Palsy: Strategic system of data aggregation, investigation, amelioration and no-fault compensation. J Obstet Gynaecol Res 2019; 45:493-513. [DOI: 10.1111/jog.13906] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Shin Ushiro
- Division of Patient Safety; Kyushu University Hospital; Fukuoka Japan
- Japan Council for Quality Health Care, Tokyo; Japan
| | | | - Shigeru Ueda
- Japan Council for Quality Health Care, Tokyo; Japan
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Mutoh T, Mutoh T, Kurosaki H, Shimomura H, Taki Y. Development and exploration of a Japanese version of the cerebral palsy quality of life for children questionnaire for primary caregivers: a pilot study. J Phys Ther Sci 2019; 31:724-728. [PMID: 31631945 PMCID: PMC6751053 DOI: 10.1589/jpts.31.724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/15/2019] [Indexed: 11/29/2022] Open
Abstract
[Purpose] We aimed to translate and validate a Japanese language version of the cerebral
palsy quality of life for children questionnaire for primary caregivers and assess the
relationship between quality of life of Japanese parents and their children’s motor
skills. [Participants and Methods] Fifty children (aged 4 to 12 years) and their parents
(mothers) were enrolled. The parent-proxy version of the cerebral palsy quality of life
for children questionnaire translated to Japanese was administered, and a validation study
was performed using Cronbach’s α as the key metric. The relationships between the parents’
quality of life and children’s Gross Motor Function Classification Scale levels were
analyzed. [Results] We found that the age of the children and their parents and gender of
the children were not significant factors affecting the quality of life domains.
Significantly high values of internal consistency were detected among items within each
quality of life domain, wherein Cronbach’s α was between 0.72 and 0.89. Two quality of
life domains (Emotional well-being and Feeling about functioning) were significantly
associated with Gross Motor Function Classification Scale levels. [Conclusion] Our data
suggest that the original English version of the cerebral palsy quality of life for
children questionnaire for primary caregivers was successfully translated to Japanese for
use by Japanese-speaking parents caring for their children.
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Affiliation(s)
- Tomoko Mutoh
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University: 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
- Division of Clinical Psychology, Graduate School of Human Sciences, Kobe Shoin Women’s University, Japan
| | - Tatsushi Mutoh
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University: 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Hiromi Kurosaki
- Division of Clinical Psychology, Graduate School of Human Sciences, Kobe Shoin Women’s University, Japan
| | - Hideo Shimomura
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University: 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Yasuyuki Taki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University: 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
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The neurorestorative effect of human amniotic fluid stem cells on the chronic phase of neonatal hypoxic-ischemic encephalopathy in mice. Pediatr Res 2019; 85:97-104. [PMID: 30120407 DOI: 10.1038/s41390-018-0131-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/25/2018] [Accepted: 07/22/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) remains a major cause of cerebral palsy. Increasing evidence has suggested that mesenchymal stem cells have a favorable effect on HIE. However, the efficacy of human amniotic fluid stem cells (hAFS) for HIE, especially in the chronic phase, remains unclear. The aim of this study was to determine the neurorestorative effect of hAFS on the chronic phase of HIE. METHODS hAFS were isolated from AF cells as CD117-positive cells. HI was induced in 9-day-old mice. Animals intranasally received hAFS or phosphate-buffered saline at 10 days post HI and were harvested for histological analysis after functional tests at 21 days post HI. We also implanted PKH26-positive hAFS to assess their migration to the brain. Finally, we determined gene expressions of trophic factors in hAFS co-cultured with HI brain extract. RESULTS hAFS improved sensorimotor deficits in HIE by gray and white matter restoration and neuroinflammation reduction followed by migration to the lesion. Brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), hepatocyte growth factor (HGF), and stromal cell-derived factor-1 (SDF-1) gene expressions in hAFS were elevated when exposed to HI-induced brain extract. CONCLUSION hAFS induced functional recovery by exerting neurorestorative effects in HIE mice, suggesting that intranasal administration of hAFS could be a novel treatment for HIE, especially in the chronic phase.
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Xiao D, Qu Y, Huang L, Wang Y, Li X, Mu D. Association between maternal overweight or obesity and cerebral palsy in children: A meta-analysis. PLoS One 2018; 13:e0205733. [PMID: 30325944 PMCID: PMC6191132 DOI: 10.1371/journal.pone.0205733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/01/2018] [Indexed: 01/23/2023] Open
Abstract
CONTEXT There is no consensus regarding the association between maternal obesity or overweight and cerebral palsy (CP) in children. OBJECTIVES To investigate whether maternal obesity or overweight is associated with CP and identify the factors that explain the differences in the study results. DATA SOURCES We conducted a meta-analysis of studies published in English with titles or abstracts that discussed the relationships between maternal obesity or overweight and CP before August 23, 2017, using Ovid Medline, EMBASE and Web of Science. STUDY SELECTION Of 2699 initially identified studies, 8 studies that addressed the association between maternal obesity and CP met our final inclusion criteria. DATA EXTRACTION Information from the individual studies was abstracted using standardized forms by 2 independent observers who were blinded to the authors' names and journal titles. DATA SYNTHESIS According to a random effects model, maternal overweight was significantly associated with CP in offspring [RR = 1.29 (95% CI, 1.04-1.60), heterogeneity (I2 = 45.5%, P = 0.103)]; maternal obesity was significantly associated with CP in offspring [RR = 1.45 (95% CI, 1.25-1.69), heterogeneity (I2 = 24.1%, P = 0.253)]; and maternal obesity III was significantly associated with CP in offspring [RR = 2.25 (95% CI, 1.82-2.79), heterogeneity (I2 = 0%, P = 0.589)]. However, maternal underweight was not significantly associated with CP in offspring [RR = 1.11 (95% CI, 0.88-1.38), low heterogeneity (I2 = 0%, P = 0.435)]. Factors that explained the differences in the meta-analysis results included study design, study location, and whether individual studies adjusted for potential confounders. CONCLUSION This study suggests that maternal obesity and overweight increase the risk of CP in offspring. Further studies are required to confirm these results and determine the influence of variables across studies.
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Affiliation(s)
- Dongqiong Xiao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Lan Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yan Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xihong Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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Hasegawa J, Ikeda T, Toyokawa S, Jojima E, Satoh S, Ichizuka K, Tamiya N, Nakai A, Fujimori K, Maeda T, Masuzaki H, Takeda S, Suzuki H, Ueda S, Ikenoue T. Relevant obstetric factors associated with fetal heart rate monitoring for cerebral palsy in pregnant women with hypertensive disorder of pregnancy. J Obstet Gynaecol Res 2018; 44:647-654. [PMID: 29363232 PMCID: PMC5900742 DOI: 10.1111/jog.13555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/21/2017] [Indexed: 11/30/2022]
Abstract
AIM The study identifies the relevant obstetric factors associated with fetal heart rate (FHR) monitoring for cerebral palsy (CP) in pregnant women with hypertensive disorders of pregnancy (HDP). METHODS The subjects were neonates with CP (birth weight ≥ 2000 g, gestational age ≥ 33 weeks) who were approved for compensation for CP by the Operating Organization of the Japan Obstetric Compensation System between 2009 and 2012. After selection of women with antepartum HDP, obstetric characteristics associated with FHR monitoring were analyzed. RESULTS The subjects included 33 neonates with CP whose mothers suffered from HDP during pregnancy and 450 neonates whose mothers did not develop HDP. The rates of placental abruption (48.5% vs. 20%; P < 0.001) and light-for-gestational age (12.1% vs. 2.2%; P = 0.011) were significantly higher in women with HDP than in those without HDP. Regarding FHR pattern analysis, fetal bradycardia was observed on admission to hospital in 94% of women with placental abruption. In women without placental abruption, FHR was likely to indicate a favorable pattern on admission, but became worse with the progression of labor. CONCLUSION This is first study to clinically demonstrate FHR patterns in CP cases in association with HDP. Although antepartum CP is undetectable, pregnant women with HDP should be placed under strict observation and management to minimize fetal hypoxic conditions during labor.
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Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics and GynecologySt. Marianna University School of MedicineKawasakiJapan
| | - Tomoaki Ikeda
- Department of Obstetrics and GynecologyMie University Graduate School of MedicineTsuJapan
| | | | - Emi Jojima
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated FoundationJapan Council for Quality Health CareTokyoJapan
| | - Shoji Satoh
- Maternal and Perinatal Care CenterOita Prefectural HospitalOitaJapan
| | - Kiyotake Ichizuka
- Department of Obstetrics and GynecologyShowa University Northern Yokohama HospitalYokohamaJapan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Akihito Nakai
- Department of Obstetrics and GynecologyNippon Medical SchoolTokyoJapan
| | - Keiya Fujimori
- Department of Obstetrics and GynecologyFukushima Medical UniversityFukushimaJapan
| | - Tsugio Maeda
- Maeda ClinicIncorporated Association Anzu‐kaiYaizuJapan
| | - Hideaki Masuzaki
- Department of Obstetrics and GynecologyThe University of NagasakiNagasakiJapan
| | - Satoru Takeda
- Department of Obstetrics & GynecologyJuntendo UniversityTokyoJapan
| | - Hideaki Suzuki
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated FoundationJapan Council for Quality Health CareTokyoJapan
| | - Shigeru Ueda
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated FoundationJapan Council for Quality Health CareTokyoJapan
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Causes and risk factors for singleton stillbirth in Japan: Analysis of a nationwide perinatal database, 2013-2014. Sci Rep 2018. [PMID: 29515220 PMCID: PMC5841302 DOI: 10.1038/s41598-018-22546-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Over 80% of perinatal mortality in Japan is due to stillbirths after 22 weeks of gestation, with one in 300 families experiencing fetal loss every year. This study aimed to assess causes and risk factors for singleton stillbirth in Japan. A retrospective cross-sectional study was conducted using the Japan Society of Obstetrics and Gynecology Perinatal Database from January 2013 to December 2014. A total of 379,211 births including 2,133 stillbirths were analyzed. Causes of death were classified into eight categories. A multi-level Poisson regression model was used to assess the relationship between stillbirth and key covariates. Causes of death were unknown in 25–40% of stillbirths across gestational age. Placental abnormality accounted for the largest proportion of known causes, followed by umbilical cord abnormality. Stillbirth risk was increased among small-for-gestational-age infants (adjusted relative risk [ARR]: 3.78, 95% confidence interval [CI]: 3.31–4.32) and nulliparous women (ARR: 1.19, 95% CI: 1.05–1.35). Maternal underweight, pregnancy-induced hypertension and oligohydramnios showed a protective effect. Our finding suggests that stillbirths occurring among women with known complications are likely already being prevented. Further reduction in stillbirths must target small-sized fetuses and nulliparous women. Improved recording of the causal pathways of stillbirths is also needed.
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Human Amniotic Fluid Stem Cells: Therapeutic Potential for Perinatal Patients with Intractable Neurological Disease. Keio J Med 2018. [PMID: 29515049 DOI: 10.2302/kjm.2017-0019-ir] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mesenchymal stem cells (MSCs) have generated great interest in the fields of regenerative medicine and immunotherapy because of their unique biological properties. Among MSCs, amniotic fluid stem cells (AFS) have a number of characteristics that make them attractive candidates for tissue engineering and cell replacement strategies, particularly for perinatal medicine. If various neonatal conditions, including birth asphyxia, preterm birth, and congenital abnormalities, which result in long-lasting severe impairments, could be predicted during pregnancy, it would allow collection of small samples of amniotic fluid cells by amniocentesis. In vitro culture of these autologous AFS during pregnancy would make them available for use soon after birth. Hypoxic-ischemic encephalopathy (HIE) and myelomeningocele (MMC) are neonatal conditions that cause permanent neurological disability, for which the treatment options are extremely limited. Experiments using animal models of HIE and MMC and human clinical trials have demonstrated that MSCs, including AFS, have beneficial effects on the central nervous system through paracrine influences, indicating that autologous AFS treatment may be applicable for intractable neurological diseases, including HIE and MMC, during the perinatal period. In this review, we focus on recent research related to the therapeutic potential of AFS for perinatal neurological diseases such as HIE and MMC.
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Mutoh T, Mutoh T, Tsubone H, Takada M, Doumura M, Ihara M, Shimomura H, Taki Y, Ihara M. Impact of serial gait analyses on long-term outcome of hippotherapy in children and adolescents with cerebral palsy. Complement Ther Clin Pract 2018; 30:19-23. [DOI: 10.1016/j.ctcp.2017.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/22/2017] [Accepted: 11/07/2017] [Indexed: 02/03/2023]
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Hasegawa J. Ultrasound screening of umbilical cord abnormalities and delivery management. Placenta 2018; 62:66-78. [DOI: 10.1016/j.placenta.2017.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 12/26/2022]
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Maeda E, Ishihara O, Tomio J, Sato A, Terada Y, Kobayashi Y, Murata K. Cesarean section rates and local resources for perinatal care in Japan: A nationwide ecological study using the national database of health insurance claims. J Obstet Gynaecol Res 2017; 44:208-216. [DOI: 10.1111/jog.13518] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/08/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Eri Maeda
- Department of Environmental Health Sciences; Akita University Graduate School of Medicine; Akita Japan
| | - Osamu Ishihara
- Department of Obstetrics and Gynecology; Saitama Medical University; Saitama Japan
| | - Jun Tomio
- Department of Public Health, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Aya Sato
- Department of Environmental Health Sciences; Akita University Graduate School of Medicine; Akita Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology; Akita University Graduate School of Medicine; Akita Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Katsuyuki Murata
- Department of Environmental Health Sciences; Akita University Graduate School of Medicine; Akita Japan
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Vasquez-Vivar J, Shi Z, Luo K, Thirugnanam K, Tan S. Tetrahydrobiopterin in antenatal brain hypoxia-ischemia-induced motor impairments and cerebral palsy. Redox Biol 2017; 13:594-599. [PMID: 28803128 PMCID: PMC5554922 DOI: 10.1016/j.redox.2017.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 12/24/2022] Open
Abstract
Antenatal brain hypoxia-ischemia, which occurs in cerebral palsy, is considered a significant cause of motor impairments in children. The mechanisms by which antenatal hypoxia-ischemia causes brain injury and motor deficits still need to be elucidated. Tetrahydrobiopterin is an important enzyme cofactor that is necessary to produce neurotransmitters and to maintain the redox status of the brain. A genetic deficiency of this cofactor from mutations of biosynthetic or recycling enzymes is a well-recognized factor in the development of childhood neurological disorders characterized by motor impairments, developmental delay, and encephalopathy. Experimental hypoxia-ischemia causes a decline in the availability of tetrahydrobiopterin in the immature brain. This decline coincides with the loss of brain function, suggesting this occurrence contributes to neuronal dysfunction and motor impairments. One possible mechanism linking tetrahydrobiopterin deficiency, hypoxia-ischemia, and neuronal injury is oxidative injury. Evidence of the central role of the developmental biology of tetrahydrobiopterin in response to hypoxic ischemic brain injury, especially the development of motor deficits, is discussed.
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Affiliation(s)
- Jeannette Vasquez-Vivar
- Department of Biophysics and Redox Biology Program, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Zhongjie Shi
- Wayne State University School of Medicine and Children's Hospital of Michigan, 3901 Beaubien, Room 5177, Carls Bldg., Detroit, MI 48201, USA
| | - Kehuan Luo
- Wayne State University School of Medicine and Children's Hospital of Michigan, 3901 Beaubien, Room 5177, Carls Bldg., Detroit, MI 48201, USA
| | - Karthikeyan Thirugnanam
- Department of Biophysics and Redox Biology Program, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Sidhartha Tan
- Wayne State University School of Medicine and Children's Hospital of Michigan, 3901 Beaubien, Room 5177, Carls Bldg., Detroit, MI 48201, USA.
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Downes KL, Grantz KL, Shenassa ED. Maternal, Labor, Delivery, and Perinatal Outcomes Associated with Placental Abruption: A Systematic Review. Am J Perinatol 2017; 34:935-957. [PMID: 28329897 PMCID: PMC5683164 DOI: 10.1055/s-0037-1599149] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective Risk factors for placental abruption have changed, but there has not been an updated systematic review investigating outcomes. Methods We searched PubMed, EMBASE, Web of Science, SCOPUS, and CINAHL for publications from January 1, 2005 through December 31, 2016. We reviewed English-language publications reporting estimated incidence and/or risk factors for maternal, labor, delivery, and perinatal outcomes associated with abruption. We excluded case studies, conference abstracts, and studies that lacked a referent/comparison group or did not clearly characterize placental abruption. Results A total of 123 studies were included. Abruption was associated with elevated risk of cesarean delivery, postpartum hemorrhage and transfusion, preterm birth, intrauterine growth restriction or low birth weight, perinatal mortality, and cerebral palsy. Additional maternal outcomes included relaparotomy, hysterectomy, sepsis, amniotic fluid embolism, venous thromboembolism, acute kidney injury, and maternal intensive care unit admission. Additional perinatal outcomes included acidosis, encephalopathy, severe respiratory disorders, necrotizing enterocolitis, acute kidney injury, need for resuscitation, chronic lung disease, infant death, and epilepsy. Conclusion Few studies examined outcomes beyond the initial birth period, but there is evidence that both mother and child are at risk of additional adverse outcomes. There was also considerable variation in, or absence of, the reporting of abruption definitions.
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Affiliation(s)
- Katheryne L. Downes
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Maternal and Child Health Program, University of Maryland, College Park, Maryland
- Department of Obstetrics and Gynecology, Center for Research in Reproduction and Women’s Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine L. Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Edmond D. Shenassa
- Maternal and Child Health Program, University of Maryland, College Park, Maryland
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland
- Department of Epidemiology and Biostatistics, University of Maryland, Baltimore, Maryland
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No fault compensation in perinatal medicine in Japan-from results for 8 years. Obstet Gynecol Sci 2017; 60:139-144. [PMID: 28344954 PMCID: PMC5364095 DOI: 10.5468/ogs.2017.60.2.139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 11/18/2022] Open
Abstract
No fault compensation in perinatal medicine has been established to provide aid to patients in the event of disability due to a medical accident during delivery and to strive to resolve disputes quickly that contributes to reduce medical malpractice suit in the field of perinatal medicine. Furthermore, this system is aimed to establish a mechanism that achieves higher quality of obstetric care by analyzing the causes of accidents. This system is operated by Japan Council for Quality Health Care and 99.9% of childbirth facilities in Japan registered with this compensation system. Compensation system has two major functions including compensation and cause analysis and recurrence prevention based on cases. Compensation eligibility is reviewed in the Review Committee at the organization in Japan Council for Quality Health Care and currently 1,717 cases are judged as eligible cases out of 2,250 since 2009. The cause of each eligible case is analyzed in the Cause Analysis Committee one by one. The Cause Analysis Committee has 7 independent subcommittee and each subcommittee members are consistent of obstetricians, neonatologists, pediatricians, midwives and lawyers. Original cause analysis report is sent to childbirth facility and patient's family. Questionnaire survey demonstrated that 73% of childbirth facilities and 65% of patient family were satisfied with the cause analysis report. The number of medical lawsuit in obstetrics and gynecology is significantly decreased compared to those in all medical departments since the compensation system was introduced suggesting that these cause analysis reports may contribute the decrease in medical lawsuits. The major purpose of the Recurrence Prevention Committee is striving to prevent future cases of cerebral palsy and to improve the quality of obstetric care. To accomplish the purpose, the committee routinely collect information from individual cases and analyze quantitatively and epidemiologically. Furthermore the committee choose subject from cases to discuss for future prevention and provide wide public disclosure of the information with recommendation. The committee issued 6 reports until now and these reports have been distributed to childbirth facilities, perinatal medicine-related scientific society and administrative agencies.
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Toyokawa S, Maeda E, Kobayashi Y. Estimation of the number of children with cerebral palsy using nationwide health insurance claims data in Japan. Dev Med Child Neurol 2017; 59:317-321. [PMID: 27644438 DOI: 10.1111/dmcn.13278] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 11/29/2022]
Abstract
AIM Japan lacks a population-based registration system for cerebral palsy (CP), therefore the nationwide prevalence of CP is unknown. Our aim was to estimate the number of children with CP using the National Database of Health Insurance Claims and Specific Health Checkups of Japan, which has been recently developed by the government. METHOD Study participants were children and adolescents aged below 20 years, who had been assigned CP diagnosis codes more than once in claims issued between June 2012 and May 2013 from all health insurance schemes in Japan, except for Social Welfare and Elderly Health Insurance. RESULTS The number of participants with diagnosed CP was 44 381. The number of males with CP (25 237) was greater than the number of females (19 144). Peak CP prevalence per 1000 population was 2.39 at age 4 years, and this gradually declined with age. The prevalence of CP per 1000 population was 2.27 at age 5 to 9 years. The numbers of inpatients and outpatients with CP were 9126 (20.6%) and 35 255 (79.4%) respectively. INTERPRETATION Our estimation of CP prevalence per 1000 population at age 5 to 9 years lay in the higher range of figures from previous studies in Japan, and was close to figures reported by European countries.
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Affiliation(s)
- Satoshi Toyokawa
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eri Maeda
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Matsuda Y, Sasaki K, Kakinuma K, Kakinuma T, Tagawa M, Imai K, Nonaka H, Ohwada M, Satoh S. Impact of risk factors for perinatal events in Japan: Introduction of a newly created perinatal event score. J Obstet Gynaecol Res 2017; 43:805-811. [PMID: 28168779 DOI: 10.1111/jog.13278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/19/2016] [Accepted: 12/03/2016] [Indexed: 11/29/2022]
Abstract
AIM A cohort study was performed to clarify the influence of risk factors on perinatal events (obstetric complications and/or perinatal deaths). METHODS This cohort study reviewed 395 785 births from 2011 to 2013. Women with singleton pregnancies delivered after 22 weeks of gestation were included. The OR were determined on multivariate analysis. The perinatal event score (PES) for risk factors, which is the product of the OR of risk factors for obstetric complications, OR of risk factors for perinatal death, and OR of obstetric complications for perinatal death, was introduced to clarify the impact of each risk combination. RESULTS There were 20 risk factors such as maternal age and medical complications relating to the 11 obstetric complications, including pregnancy-induced hypertension and preterm labor. As a result, 77 combinations of risk factors and obstetric complications were found to be significant. Six obstetric complications such as preterm labor and cervical insufficiency were found to be related to perinatal death. Two factors were found to be directly related to perinatal death: age >40 years old (OR, 1.24; 95%CI: 1.11-1.39) and essential hypertension (OR, 1.56; 95%CI: 1.19-2.05). As a result, PES ranged from 1.07 (primipara for premature rupture of membrane) to 40.1 (essential hypertension for placental abruption), and high PES (≥8) was identified in 21 combinations of risk factors and obstetric complications. CONCLUSION This newly created score for perinatal events, PES, can be used as an indicator of the impact of risk factors on perinatal events.
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Affiliation(s)
- Yoshio Matsuda
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Kemal Sasaki
- Child Health Center, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Miki Tagawa
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Ken Imai
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Hiroaki Nonaka
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Shoji Satoh
- Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan
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