Relevant Obstetric Factors for Cerebral Palsy: From the Nationwide Obstetric Compensation System in Japan

Abstract

ObjectiveThe aim of this study was to identify the relevant obstetric factors for cerebral palsy (CP) after 33 weeks’ gestation in Japan.Study designThis retrospective case cohort study (1:100 cases and controls) used a Japanese national CP registry. Obstetric characteristics and clinical course were compared between CP cases in the Japan Obstetric Compensation System for Cerebral Palsy database and controls in the perinatal database of the Japan Society of Obstetrics and Gynecology born as live singleton infants between 2009 and 2011 with a birth weight ≥ 2,000 g and gestation ≥ 33 weeks.ResultsOne hundred and seventy-five CP cases and 17,475 controls were assessed. Major relevant single factors for CP were placental abnormalities (31%), umbilical cord abnormalities (15%), maternal complications (10%), and neonatal complications (1%). A multivariate regression model demonstrated that obstetric variables associated with CP were acute delivery due to non-reassuring fetal status (relative risk [RR]: 37.182, 95% confidence interval [CI]: 20.028–69.032), uterine rupture (RR: 24.770, 95% CI: 6.006–102.160), placental abruption (RR: 20.891, 95% CI: 11.817–36.934), and preterm labor (RR: 3.153, 95% CI: 2.024–4.911), whereas protective factors were head presentation (RR: 0.199, 95% CI: 0.088–0.450) and elective cesarean section (RR: 0.236, 95% CI: 0.067–0.828).ConclusionCP after 33 weeks’ gestation in the recently reported cases in Japan was strongly associated with acute delivery due to non-reassuring fetal status, uterine rupture, and placental abruption.

Cesarean section rates and local resources for perinatal care in Japan: A nationwide ecological study using the national database of health insurance claims

“…frequent cesarean deliveries on Fridays and a lower CS rate among laborists), limited and unconsolidated medical resources in Japan may be associated with the increased CS rate. In addition to workload, a recent increase in medical conflicts over perinatal complications may lead obstetricians toward defensive medicine if the availability of prompt intensive care is not ensured. Despite these issues, the relationship between CS rates and factors related to perinatal care resources in the community has not yet been investigated.…”

Estimation of the number of children with cerebral palsy using nationwide health insurance claims data in Japan

“…A no‐fault compensation system, the Japan Obstetric Compensation System for Cerebral Palsy, was launched in 2009. Children with severe CP caused by trauma during labor and delivery, who are identified by the system, receive insurance benefits until the age of 20 years . Knowledge of the precise number of children with CP is necessary to reform the system's premium, insurance benefits, and coverage.…”

Estudio de las compensaciones económicas sobre sentencias contra obstetras y ginecólogos en España (1987-2013)

“…27 Despite the known heterogeneity in the causes of childhood cerebral palsy, and that few cases are exclusively related to severe hypoxia during childbirth, 28---30 it seems appropriate to repeat that there are events that occur only at the time of childbirth and whose complications may result in this crippling disease. 31,32 Claims that end in conviction for this latter complication include virtually all the ''catastrophic'' compensation awards and can be considered as a benchmark for the calculation of insurance premiums in obstetrics, which are among the highest. 33 Extreme cases, which are the most high-profile ones, 3 can create uncertainty regarding the system's safety by relating them to negligent acts 34 ; however, these are rare cases and only account for a small number of medical errors.…”