{"title":"神经轴镇痛对分娩中脑瘫影响因素的探索性分析：来自日本脑瘫产科补偿制度。","authors":"Tatsuya Arakaki, Junichi Hasegawa, Akihiko Sekizawa, Tomoaki Ikeda, Isamu Ishiwata","doi":"10.1111/jog.70030","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aim</h3>\n \n <p>This study aimed to reveal factors contributing to cerebral palsy owing to intrapartum hypoxia during labor involving neuraxial analgesia using a nationwide database in Japan.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We retrospectively reviewed 102 reports of cases involving the use of anesthesia during labor, selected from reports on the causes of cerebral palsy, which were analyzed by the Japan Obstetric Compensation System Causal Analysis Committee between 2009 and 2019. Among these, 85 deliveries involved neuraxial analgesia. Of these, 39 cases were identified in which cerebral palsy was associated with intrapartum hypoxia and acidosis. These cases were classified into three categories based on the presumed contributing factors to cerebral palsy, namely anesthesia-related complications, obstetric complications, and labor progress. Clinical characteristics and intrapartum management issues were descriptively analyzed.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Neuraxial analgesia was implicated in five of the 39 cases (12.8%), with direct involvement in one case of total spinal anesthesia. Obstetric complications (20.5%) and labor progress-related issues (76.9%) were more frequently associated with cerebral palsy. Intrapartum management problems were identified in most cases, including inappropriate cardiotocography interpretation (79.5%) and uterotonic use (38.5%). Anesthesia-related concerns, such as insufficient maternal or fetal monitoring, were observed in some cases.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Neuraxial analgesia was infrequently the direct cause of cerebral palsy; however, suboptimal labor management was identified in many cases. Improved monitoring, timely intervention, and standardized protocols are essential to reduce cerebral palsy risk during neuraxial analgesia-supported deliveries. Although rare, serious anesthesia-related complications also underscore the significance of vigilance in anesthetic practice.</p>\n </section>\n </div>","PeriodicalId":16593,"journal":{"name":"Journal of Obstetrics and Gynaecology Research","volume":"51 8","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Exploratory analysis of contributory factors for cerebral palsy during labor involving neuraxial analgesia: From the Japan Obstetric Compensation System for Cerebral Palsy\",\"authors\":\"Tatsuya Arakaki, Junichi Hasegawa, Akihiko Sekizawa, Tomoaki Ikeda, Isamu Ishiwata\",\"doi\":\"10.1111/jog.70030\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Aim</h3>\\n \\n <p>This study aimed to reveal factors contributing to cerebral palsy owing to intrapartum hypoxia during labor involving neuraxial analgesia using a nationwide database in Japan.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We retrospectively reviewed 102 reports of cases involving the use of anesthesia during labor, selected from reports on the causes of cerebral palsy, which were analyzed by the Japan Obstetric Compensation System Causal Analysis Committee between 2009 and 2019. Among these, 85 deliveries involved neuraxial analgesia. Of these, 39 cases were identified in which cerebral palsy was associated with intrapartum hypoxia and acidosis. These cases were classified into three categories based on the presumed contributing factors to cerebral palsy, namely anesthesia-related complications, obstetric complications, and labor progress. Clinical characteristics and intrapartum management issues were descriptively analyzed.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Neuraxial analgesia was implicated in five of the 39 cases (12.8%), with direct involvement in one case of total spinal anesthesia. Obstetric complications (20.5%) and labor progress-related issues (76.9%) were more frequently associated with cerebral palsy. Intrapartum management problems were identified in most cases, including inappropriate cardiotocography interpretation (79.5%) and uterotonic use (38.5%). Anesthesia-related concerns, such as insufficient maternal or fetal monitoring, were observed in some cases.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Neuraxial analgesia was infrequently the direct cause of cerebral palsy; however, suboptimal labor management was identified in many cases. Improved monitoring, timely intervention, and standardized protocols are essential to reduce cerebral palsy risk during neuraxial analgesia-supported deliveries. Although rare, serious anesthesia-related complications also underscore the significance of vigilance in anesthetic practice.</p>\\n </section>\\n </div>\",\"PeriodicalId\":16593,\"journal\":{\"name\":\"Journal of Obstetrics and Gynaecology Research\",\"volume\":\"51 8\",\"pages\":\"\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-08-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Obstetrics and Gynaecology Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://obgyn.onlinelibrary.wiley.com/doi/10.1111/jog.70030\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Obstetrics and Gynaecology Research","FirstCategoryId":"3","ListUrlMain":"https://obgyn.onlinelibrary.wiley.com/doi/10.1111/jog.70030","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Exploratory analysis of contributory factors for cerebral palsy during labor involving neuraxial analgesia: From the Japan Obstetric Compensation System for Cerebral Palsy
Aim
This study aimed to reveal factors contributing to cerebral palsy owing to intrapartum hypoxia during labor involving neuraxial analgesia using a nationwide database in Japan.
Methods
We retrospectively reviewed 102 reports of cases involving the use of anesthesia during labor, selected from reports on the causes of cerebral palsy, which were analyzed by the Japan Obstetric Compensation System Causal Analysis Committee between 2009 and 2019. Among these, 85 deliveries involved neuraxial analgesia. Of these, 39 cases were identified in which cerebral palsy was associated with intrapartum hypoxia and acidosis. These cases were classified into three categories based on the presumed contributing factors to cerebral palsy, namely anesthesia-related complications, obstetric complications, and labor progress. Clinical characteristics and intrapartum management issues were descriptively analyzed.
Results
Neuraxial analgesia was implicated in five of the 39 cases (12.8%), with direct involvement in one case of total spinal anesthesia. Obstetric complications (20.5%) and labor progress-related issues (76.9%) were more frequently associated with cerebral palsy. Intrapartum management problems were identified in most cases, including inappropriate cardiotocography interpretation (79.5%) and uterotonic use (38.5%). Anesthesia-related concerns, such as insufficient maternal or fetal monitoring, were observed in some cases.
Conclusions
Neuraxial analgesia was infrequently the direct cause of cerebral palsy; however, suboptimal labor management was identified in many cases. Improved monitoring, timely intervention, and standardized protocols are essential to reduce cerebral palsy risk during neuraxial analgesia-supported deliveries. Although rare, serious anesthesia-related complications also underscore the significance of vigilance in anesthetic practice.
期刊介绍：
The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology.
The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.
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