**4.1 Publication of annual prevention reports, educational materials on fetal heart rate monitoring, and leaflets for professionals and expectant mothers**

The investigative reports are collectively analyzed in order to prevent recurrence and to improve quality in perinatal care [15]. Here, we applied the knowledge and procedure devised through the medical adverse event reporting and learning system that the JQ had run for more than a decade to produce materials for effective prevention of CP through collective analysis. Specifically, the JQ conducted a quantitative and epidemiological analysis of aggregated cases to produce report for prevention on annual basis based on such data as status of pregnancy, clinical courses of pregnancy, delivery and neonatal condition, and the local context of healthcare delivery system [16]. The JQ also produced educational materials such as fetal heart rate monitoring textbook of profound CPs and leaflets for medical professionals and pregnant women [17].

#### **4.2 Scientific achievements of the Prevention Working Group**

Under the Prevention Committee, a working group for prevention, which consists of obstetricians nominated by the Japan Society of Obstetrics and Gynecology (JSOG) and the Japan Association of Obstetricians and Gynecologists (JAOG), as well as academic experts such as epidemiologists, was established in May 2014 that has carried out data analysis of the aggregated Investigative Reports. With the data, comparative study between the data of CPs that were subject to compensation in this system and that of the "Japan Society of Obstetrics and Gynecology Perinatal Registration Database" was conducted. In addition, an analysis of intrauterine infections and fetal heart rate patterns in children with CP was conducted in response to the requests mentioned in the Prevention Report to the relevant academic societies and organizations. The analyses have been

#### **Figure 4.**

*Educative book on CTG pattern of CPs.*

implemented in the working group from such multifaceted viewpoints as obstetrics and public health.

As the system requests that childbirth facility submit application with relevant documents such as medical chart, cardiotocogram (CTG) recording and so on, the system happened to provided experts an opportunity to scientifically look into CTG data through collective analysis. It is normally difficult in Japan to obtain CTG data of profound cerebral palsy as it suddenly happens at any childbirth facility across the country. Taking advantage of the considerable number of CTG recordings, the experts published an educational book on CTG interpretation, which is available on the website of the system (**Figure 4**) [18].
