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Background This study aimed to estimate population-based frequencies of various fetal heart rate (FHR) evolution patterns in cases with umbilical cord abnormalities and to identify particular FHR evolution patterns associated with different types of umbilical cord abnormalities. Methods We conducted a retrospective cohort study. FHR evolution patterns, evaluating the trend of all FHR tracings from admission to delivery, were retrospectively analyzed and classified into five categories: persistent non-reassuring (p-NR), persistent bradycardia, Hon’s pattern, reactive-prolonged deceleration (PD), and persistent reassuring. The study included pregnant women who delivered after 37 weeks of gestation. Frequencies of the five FHR evolution pattern categories were stratified by the type of umbilical cord abnormalities. Results Among 1,195 participants, 1,074 had no cord abnormalities, and 122 had abnormalities. Overall, the prevalence of FHR patterns in cases with the cord abnormality was: 2% p-NR, 3% Hon’s pattern, 21% reactive-PD, and 74% persistent reassuring. The frequencies of various FHR evolution patterns did not differ significantly between cases with and without umbilical cord abnormalities. However, when analyzing specific cord abnormalities, velamentous cord insertion showed a higher prevalence of p-NR (7% vs. 1%, p  = 0.14) and reactive-PD (40% vs. 17%, p  < 0.05) compared with cases without cord abnormality, along with a lower prevalence of persistence reassuring patterns (53% vs. 79%, p  < 0.05). Conclusion Analysis of FHR evolution patterns in a population-based sample demonstrated a higher occurrence of reactive-PD patterns in cases with umbilical cord abnormalities, which result in sudden deterioration of fetal condition during delivery, compared with cases without umbilical cord abnormalities.

Objective To clarify whether the duration from cervical ripening induction to labor onset is prolonged when epidural analgesia is administered following application of dinoprostone vaginal inserts vs. cervical ripening balloon. Methods This retrospective study included mothers with singleton deliveries at a single center between 2020–2021. Nulliparous women who underwent labor induction and requested epidural analgesia during labor after 37 weeks of gestation were included. The duration from cervical ripening induction to labor onset was compared between women using a dinoprostone vaginal insert and those using a cervical ripening balloon and between women who received epidural analgesia before and after labor onset. Results In the dinoprostone vaginal insert group, the duration was significantly shorter in the subgroup that received epidural analgesia after labor onset (estimated median, 545 [95% confidence interval: 229–861 min]) than the subgroup that received it before labor onset (estimated median, 1,570 [95% confidence interval: 1,226–1,914] min, p = 0.004). However, in the cervical ripening balloon group, the difference between subgroups was not significant. The length of labor among the groups was also not significantly different. Conclusion Epidural analgesia as labor relaxant adversely affected the progression of uterine cervical ripening when dinoprostone vaginal inserts were used, whereas it did not affect cervical ripening when a mechanical cervical dilatation balloon was used. The present results are significant for choosing the appropriate ripening method.

Fetal Vascular Malperfusion (FVM), a pathologic condition in the feto-placental circulation, is a chronic vaso-occlusive disorder in the umbilical venous blood flow. Microthrombi are caused by the umbilical cord’s blood flow deficiency in a congested umbilical vein, which also causes microvascular damage to fetal organs, especially the brain, resulting in cerebral palsy. Thrombo-occlusive events also adversely affect the upstream chorionic or stem vessels in the placenta, resulting in fetal growth restriction and fetal hypoxia. An umbilical cord structural anomaly or multiple entanglements may involve FVM. In the present report, we demonstrate a case of FVM caused by multiple umbilical cord abnormalities obtained from antenatal ultrasound Doppler findings, and we also discuss FVM, which is chronically associated with CP, comparing the ultrasonographic findings to the pathologic findings.

Purpose To compare the clinical utility of G‐banding and next‐generation sequencing (NGS) for chromosomal analysis of products of conception (POC), a crucial tool for detecting fetal chromosomal abnormalities which are major causes of miscarriage and stillbirth. Methods We evaluated the clinical utility of both techniques in a prospective analysis of 40 patients who experienced miscarriages or stillbirths between 6 and 36 weeks of gestation under Advanced Medical Care A in Japan. Both methods were applied to the same POC samples. The primary outcome was the proportion of patients with a presumed cause of miscarriage or stillbirth among all submitted samples. Results NGS presumed the cause in 75.0% (30/40) of cases, significantly outperforming G‐banding's 42.5% (17/40) (p < 0.01). G‐banding could analyze 67.5% (27/40) of the samples owing to culture failure, whereas NGS successfully analyzed all samples (100%, 40/40) (p < 0.01). Among the successfully analyzed samples, NGS presumed the cause in 70.3% (19/27) of cases, compared with 62.9% (17/27) for G‐banding (p = 0.31). For miscarriages before 12 weeks, NGS presumed the cause in 73.5% (25/34) of cases, significantly higher than the 44.1% (15/34) (p < 0.01) presumed using G‐banding. Conclusions These results highlight the superior efficacy of NGS over G‐banding for presuming causes of miscarriage or stillbirth.