ABSTRACT
Background: Aim of the study was to study role of cerebro placental ratio (CPR) as a predictor of adverse perinatal outcome in uncomplicated term pregnancies.Methods: This prospective observational study took place at the Department of Obstetrics and Gynecology in SNMC Agra. We enrolled 140 uncomplicated antenatal cases with gestational age between 37 to 41 weeks, based on specific inclusion and exclusion criteria. Each participant underwent comprehensive assessments, including history-taking, examinations, and ultrasound color Doppler evaluations. We then analyzed perinatal outcomes in correlation with CPR.Results: Adverse perinatal outcomes i.e., asphyxia and NICU admissions were found to be significantly higher in patients with CPR<1. We also observed APGAR<7 at 1 and 5 minutes, cord blood ABG with pH<7.3, pO2<50, PCO2>45 in patients with CPR<1.Conclusions: CPR serves as a noninvasive means to identify fetal compromise in seemingly healthy pregnancies, aiding in the decision-making process regarding the mode of delivery. Clinical significance-CPR can assist in stratifying at risk pregnancies, subsequently influencing decisions regarding the mode and place of delivery.
ABSTRACT
Background: The one-minute Apgar score, proven useful for rapid assessment of the neonate, is often poorly correlated with other indicators of intrauterine well-being. Fetal asphyxia is directly associated with neonatal acidosis. Umbilical cord pH is best indicator of fetal hypoxemia and hypoxemia leads to neonatal acidosis. In today scenario, fetal distress is the leading indication of emergency cesarean section.Methods: A observational cross-sectional study conducted of one year between march 2017 to February 2018; of full-term obstetric patients undergoing emergency cesarean section for fetal distress as an indication. All patients included are term gestation with low risk pregnancy excluding medical disorders and other complications of pregnancy. Immediately after delivery umbilical artertial cord blood from placental site collected and sent for pH determination and Apgar score calculated of newborn.Results: Emergency cesarean section was being done for fetal distress diagnosed based on guidelines for Intermittent auscultation; maximum patients had fetal bradycardia (240) followed by fetal tachycardia (12) and irregular rhythm (18). Relation between pH value and the fetal outcome babies who had low pH value. i.e. <7.1; had maximum referrals with poor Apgar score at 1 min (<3) and at 5 min (<3). Out of 270 babies 18 had Apgar score <3 at 1 min, out of which 10 continued to have Apgar score <3 at 5 mins. These babies were referred to department of pediatrics and were not alive beyond day 2-4.Conclusions: The values of mean Apgar score and cord blood pH decreases, which is inversely proportion to duration and severity of intrauterine/intra partum asphyxia. Umbilical arterial cord blood pH correlation was found to be significant with Apgar score in neonates delivered with indication as fetal distress.
ABSTRACT
Background: The risks of maternal morbidity and mortality associated with a caesarean section may not be reasonably justified by the degree of neonatal compromise at birth associated with caesarean section done for clinically diagnosed foetal distress. The aim was to study the association of clinical diagnosis of non-reassuring foetal status with umbilical artery acidaemia at birth in women undergoing caesarean section for foetal distress and to evaluate outcomes in neonates born by caesarean section performed for foetal distress.Methods: Prospective observational study of all the women undergoing emergency caesarean section for foetal distress at a tertiary care teaching facility over 2 months. Criteria for diagnosis of foetal distress were thick meconium stained liquor only or foetal heart rate abnormality with or without meconium stained liquor. Testing for pH was done on arterial blood drawn from umbilical cord at the time of birth. Acidaemia was defined as cord blood pH less than 7.2. Severe acidaemia was defined as cord blood pH less than 7.0.Results: Cord blood pH was analysed in 110 caesareans done for foetal distress. Incidence of neonatal acidaemia at birth in study population was 53.6%.Conclusions: Much lower incidence of actual acidaemia and low Apgar scores in neonates born by caesarean section done for clinical diagnosis of foetal distress than previously reported indicate the need for more stringent criteria and more objective tests for diagnosis of foetal distress.