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AIM: To explore the correlation between neonatal retinal hemorrhage(RH)and changes in umbilical artery blood gas analysis.METHODS: A total of 312 full-term neonates born in our obstetrics department from January 2019 to December 2021 were selected as the study subjects. According to the RetCam III fundus examination results, 245 neonates who did not experience RH were included in the control group, while 67 cases with RH were found to be included in the RH group. In addition, neonates were grouped into I degree group(n=20), II degree group(n=29), and III degree group(n=18)based on the degree of RH. General clinical data and umbilical artery blood gas analysis indicators between the RH group and the control group were compared; the levels of umbilical artery blood gas analysis indicators in neonates with different degrees of RH, the relationship between pH and RH degree, and the influencing factors of neonatal RH were analyzed.RESULTS: There was no obvious difference in maternal age, average gestational week, fetal gender, parity, gestational diabetes, fetal birth weight, and amniotic fluid between the RH group and the control group(all P>0.05), while there were obvious differences in delivery methods, gestational hypertension, forceps assisted delivery, neonatal asphyxia, and umbilical cord around the neck(all P<0.05). The pH value, arterial blood sample partial pressure(PaO2)and base excess(BE)values of the RH group were obviously lower than those of the control group(all P<0.01), while the arterial carbon dioxide partial pressure(PaCO2)was obviously higher than that of the control group(P<0.01). There were obvious differences in umbilical artery blood gas analysis indicators among children with different degrees of RH(P<0.05), and with the increase of the degree of RH, pH value, PaO2 and BE gradually decreased(P<0.05), and PaCO2 gradually increased(P<0.05). There was a negative correlation between the degree of RH and the pH of umbilical artery blood gas analysis(rs=-0.593, P<0.05). The results of multivariate Logistic regression analysis showed that delivery method, gestational hypertension, forceps assisted delivery, neonatal asphyxia, umbilical cord entanglement, pH, PaO2, PaCO2, and BE were all influencing factors for the occurrence of neonatal RH.CONCLUSION: There is a close correlation between neonatal RH and changes in umbilical artery blood gas analysis, and umbilical artery blood gas analysis can be used for the diagnosis of neonatal RH, which can be used to guide clinical treatment.
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Objective:To study the predictive values of umbilical artery blood gas analysis(UABG) plus amplitude-integrated electroencephalography(aEEG) monitoring within 6 h after birth for early complications and short term neurological outcomes in low Apgar score neonates.Methods:From January 2020 to February 2022, neonates with gestational age (GA) ≥35 weeks and 1 min or 5 min Apgar score ≤7 admitted to NICU of our hospital were retrospectively reviewed. According to UABG pH values, the neonates were assigned into pH<7.2 group and pH ≥7.2 group, and further grouped into abnormal aEEG group and normal aEEG group. The ttest, rank sum test and χ2 test were used to compare laboratory results, incidences of diseases, physical growth and neurological prognosis at 6 month of age. Results:A total of 105 neonates with low Apgar scores were enrolled, including 73 cases in the pH<7.2 group and 32 cases in the pH≥7.2 group. In the pH<7.2 group, 52(71.2%) had abnormal aEEG and 21 had normal aEEG. In the pH≥7.2 group, 6(18.8%) had abnormal aEEG and 26 had normal aEEG. The incidence of abnormal aEEG in the pH<7.2 group was higher than the pH≥7.2 group ( P<0.001). The degree of aEEG abnormality was negatively correlated with UABG pH ( r=-0.463, P<0.001). In the pH<7.2 group, the levels of creatine kinase isozymes (CK-MB), activated partial thromboplastin time and the incidence of hypoxic-ischemic encephalopathy (HIE) in neonates with abnormal aEEG were significantly higher than those with normal aEEG, and the head circumference (HC) at 6 month was significantly smaller in neonates with abnormal aEEG (all P<0.05). In the pH≥7.2 group, the level of CK-MB, incidences of HIE and respiratory failure in neonates with abnormal aEEG were higher than those with normal aEEG, HC at 6 month was smaller and the incidence of adverse neurological prognosis was higher in neonates with abnormal aEEG (all P<0.05). Conclusions:UABG plus aEEG monitoring within 6 h after birth shows predictive values for early complications and short term neurological outcomes in low Apgar scores neonates.
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Objective:To study the correlation between umbilical artery blood gas (UABG) and Apgar score of neonates and the risk factors of low base excess (BE) in UABG.Methods:From March 2017 to September 2020, newborns without congenital malformation born in three hospitals were prospectively enrolled and received UABG analysis. According to their Apgar score, the infants were assigned into low Apgar score group and normal Apgar score group. According to BE of UABG, they were assigned into BE<-12 mmol/L group and BE≥-12 mmol/L group. The UABG indexes including abnormal pH and BE between the low Apgar score group and the normal Apgar score group were compared. The risk factors of low BE in UABG were analyzed.Results:A total of 1 351 qualified samples were included including 208 cases in low Apgar score group and 1 143 cases in normal Apgar score group. 115 cases were in BE <-12 mmol/L group and 1 236 cases in BE ≥-12 mmol/L group. The incidences of abnormal pH and BE values in the low Apgar score group were higher than the normal Apgar score group [50.0% (104/208) vs. 13.8% (158/1 143), 34.6% (72/208) vs. 3.8% (43/1 143)]. The pH and BE values of UABG were positively correlated with 1 min Apgar score ( r=0.402, 0.398, P<0.001). Multivariate logistic regression analysis indicated that the risk factors for BE<-12 mmol/L were Ⅲ° contaminated amniotic fluid ( OR= 3.155, 95% CI 1.972~5.025, P<0.001) and placental abruption ( OR = 3.968, 95% CI 1.992~7.874, P <0.001). Conclusions:The pH and BE values of neonatal UABG are positively correlated with 1 min Apgar score. Ⅲ° contaminated amniotic fluid and placental abruption are risk factors of low BE in UABG.
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Objective: To explore the correlation between umbilical artery blood erythropoietin (EPO) level and perinatal factors in premature infants and its clinical significance. Methods: Umbilical artery blood samples from 107 premature infants born in the Eastern Branch of Shanghai First Maternity and Infant Hospital of Tongji University between Jan. 2019 and Jun. 2019 were collected. The levels of EPO and ferritin were measured by ELISA and chemiluminescence assay, respectively. The 107 infants were divided into three groups according to the quartile EPO level: low level group, medium level group and high level group. The relationship between umbilical artery blood EPO level and gestational age, birth body mass and other perinatal factors, the incidence of anemia of prematurity (AOP), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA) and atrial septal defect (ASD) in premature infants, and the clinical characteristics of pregnant mothers was analyzed. Results: The EPO level of umbilical artery blood in 107 newborn premature infants was 5.94-137.18 mU/mL, and the median level was 23.51 (14.60, 51.28) mU/mL. There were 26 cases in the low level group (the EPO level 14.60 mU/mL), 54 in the medium level group (14.60-51.27 mU/mL), and 27 cases in the high level group (≥51.28 mU/mL). Univariate analysis showed that the gestational age of the infants in the low level group was significantly lower than those in the medium level group and the high level group (both P < 0.05), the age of the pregnant mothers was significantly higher than those in the medium level group and the high level group (both P < 0.05), the natural pregnancy rate was significantly lower than that in the high level group (P < 0.05), and the continuous positive airway pressure (CPAP) usage rate of the infants was significantly higher than that in the medium level group (P < 0.05). The ferritin level of umbilical artery blood was significantly higher in the midium level group than that in the high level group (P < 0.05). The incidence of AOP in the high level group was significantly higher than that in the midium level group (P < 0.05). Multiple linear regression analysis showed that the EPO level of umbilical artery blood was positively correlated with the gestational age of newborn premature infants and the natural pregnancy rate of pregnant mothers (both P < 0.01). Multivariate logistic regression analysis showed that the higher the natural pregnancy rate, the higher the level of EPO in umbilical artery blood, and the higher the natural delivery rate, the lower the level of EPO in umbilical artery blood. The risks of PDA and NEC decreased and the risk of ASD increased with the increase of EPO level in umbilical artery blood (all P < 0.05). Conclusion: Conception method and delivery mode are the influencing factors of EPO level in umbilical artery blood. Monitoring the EPO level of umbilical artery blood is helpful to diagnose the common complications such as AOP, PDA, ASD and NEC in premature infants.
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Umbilical arterial blood gas is an important indicator for assessing fetal oxygenation and acid-base metabolism abnormalities. Furthermore, it is an important supplement for diagnosing neonatal asphyxia.We recommend routine umbilical arterial blood gas analysis in high-risk pregnant women with post-partum and intra-partum suspicion of fetal distress. The follow-up and treatment of high-risk infants based on blood gas results can reduce the incidence of neurological dysfunctions such as ischemic hypoxic encephalopathy and long-term cerebral palsy in the near future.
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Objective To investigate the influence of the length of time of supine ultrasound examination on the parameters of umbilical artery blood flow in the late pregnant fetus. Methods From February 2019 to June 2019,the ultrasound data of 93 pregnant women with the third-trimester pregnant were analyzed retrospectively. Fetal umbilical artery systolic／diastolic ( S／D ) ratio, resistance index ( RI ), pulsatility index ( PI ) and fetal heart rate ( HR ) were acquired at the beginning of the ultrasound examination and those after the routine ultrasound examination ( the examination of fetal, placenta and amniotic fluid). Forty-seven pregnant women from 29 to 31 weeks of gestation were assigned to around 30-week gestation group,while 46 pregnant women from 35 to 37 weeks of gestation were assigned to around 36-week gestation group. Sixty-five pregnant women with normal S／D ratio at the beginning were assigned to the initial normal group,while 28 pregnant women with abnormal S／D ratio at the beginning were assigned to the initial abnormal group. Fetal umbilical artery S／D ratio,RI,PI and HR at the beginning of the ultrasound and after the routine ultrasound examination were compared using paired sample test within around 30-week gestation group, around 36-week gestation group, initial normal and initial abnormal group, respectively. Results There was no significant difference in fetal umbilical artery S／D,RI PI and HR in the pregnant women at around 30-week gestation(all P＞0. 05). RI before the 36 week pregnant group was 0. 56 ±0. 05,and increased to 0. 58±0. 05 after the routine examination (t＝－2. 190,P＝0. 034). The S／D,RI and Pi of umbilical artery increased from 2. 36±0. 31,0. 57±0. 06,and 0. 84±0. 11 to 2. 50±0. 42,0. 59±0. 06, and 0. 88±0. 14 in the initial normal group ( t＝－3. 087,－3. 002,－2. 287,respectively; P＝0. 003,0. 004, 0. 025,respectively),of which 16 S／D increased to abnormal; the RI of umbilical artery increased from 0. 67 in the initial abnormal group ( 28 women ) after routine examination ) . The difference was statistically significant (t＝2. 616,P＝0. 014) . The ratio of S／D decreased to normal after routine examination in the initial abnormal group ( 14／28), which was higher than that in the initial normal group ( 16 ／ 65) . The difference was statistically significant ( χ2 ＝5. 771, P＜0. 05) . Conclusion Umbilical artery blood flow parameters should be measured at the beginning of the ultrasound examination in the third-trimester pregnant women. Umbilical artery Doppler ultrasound should be performed repeatedly if the pregnant woman has abnormal S／D ratio at the beginning of the examination.
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Objective To analyze the relationship between the levels of plasma total homocysteine (Hcy) and umbilical arterial with color doppler ultrasound with the severity of preeclampsia(PE).Methods A total of 70 cases of the third trimester of normal pregnancy, 72 cases of mild PE, and 66 cases of severe PE were selected.Then plasma Hcy levels and umbilical arterial with color doppler ultrasound were detected.Results Hcy levels were statistically significant difference among the normal control group,mild PE group,and severe PE group((8.950±0.585), (11.116±0.615), (14.648±0.620) μmol/L,P＜0.05).Umbilical artery blood flow parameter S/D values in severe PE group was significantly higher in mild PE group and in contrg.1 group (3.43 ±0.72 vs.2.86 ± 0.82 vs 2.75 ± 0.56, P＜ 0.05), while the control group, mild PE group had no significant difference(P＞0.05).Resistance index(RI) ,Pulsatility index(PI) in mild PE group and severe PE group were significantly higher than control group(0.60±0.05,0.78±0.07 vs.0.57±0.06;1.24±0.21,1.47±0.64 vs.0.67±0.35), and the differences among three groups were significant(P＜0.05), while the mild PE, severe PE group had no significant difference(P＞0.05).Hcy of mild PE group was positively correlated with S/D, RI and PI(r=0.548,P=0.009;r=0.587,P=0.008;r=0.324,P=0.02).Hcy of severe PE group was positively correlated with S/D,RI and PI(r=0.752,P=0.001;r=0.627,P=0.003;r =0.438,P=0.024).Hcy and the severity of PE was positively correlated (r =0.450, P ＜ 0.05), S/D and the severity of PE was positively correlated(r=0.316, P =0.002).RI, PI and the severity of PE was no correlation (r =0.024, P =0.726;r =0.054,P =0.649).Conclusion The levels of Hcy and S/D were related to the severity of PE.To reduce Hcy,and monitor S/D were new ways for the diagnosis and treatment of pre-eclampsia.
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Objective To study the inconsistent relation of twin discordancy and the umbilical artery blood flow parameter of systolic/diastolic ratio.Methods 358 pregnant women were divided into the two groups of develop-mental nonidentity( n=67 ) and developmental identity ( n=291 ) according to the criterion that the differences of twins weight exceeded 25 percent.The umbilical artery blood flow parameter of systolic/diastolic ratio were observed. Meanwhile,the difference of weight and the umbilical artery blood flow parameter of systolic/diastolic ratio in the group of developmental nonidentity were observed.Results A significant difference of the umbilical artery blood flow parameter of systolic/diastolic ratio were found in the two groups of developmental nonidentity and developmental identity(7.81%vs 32.56%,P<0.05).There were 56 cases that twins weight exceeded from 25 to 35 percent,7 cases that twins weight exceeded from 35 to 45 percent and 4 cases that twins weight exceeded 45 percent in the group of developmental nonidentity which the umbilical artery blood flow parameter of systolic/diastolic ratio were (23.66 ± 5.78)%,(27.16 ±7.25)% and (33.16 ±4.23)% correspondingly with significant difference(F=23.21,P<0.05 ) .Conclusion The umbilical artery blood flow parameter of systolic/diastolic ratio has significance in diagnosis of twin discordancy.
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OBJECTIVE: To investigate whether umbilical artery Doppler blood flow velocity waveform is effective in predicting perinatal outcome of term pregnancies with small for gestational age (SGA). METHODS: A total of 381 patients at 37~41 weeks of gestational age (GA) who received antenatal umbilical artery Doppler blood flow test and delivered singleton SGA infants. The ratio of peak-systolic to end-diastolic (S/D) blood flow velocities in the umbilical artery was measured in each patient. The patients were divided into a normal group (n=307) with a S/D ratio equal to or less than 3.0, and an abnormal group with a S/D ratio of greater than 3.0 (n=74). These groups were comparatively analysed with respect to maternal characteristics and neonatal outcomes. Results: There were no significant differences between the two groups in mean maternal age, gestational age at the time of delivery, and cesarean section rate due to fetal distress. There was significantly increased incidence of hypertensive disorders in pregnancy in the abnormal S/D ratio group. And the abnormal S/D ratio group showed lower neonatal birthweight, higher incidence of admission to neonatal intensive care unit (NICU), and longer stay in neonatal intensive care unit. According to linear regression, in pregnancies complicated by SGA, abnormal S/D ratio was still a risk factor for low birthweight even after controlling for the incidence of hypertension. Conclusion: In term pregnancies accompanied by SGA, abnormal umbilical artery S/D ratio is an independent predictor of neonatal birth weight, incidence of admission to NICU, and NICU stay.
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Humans , Infant , Infant, Newborn , Pregnancy , Blood Flow Velocity , Fetal Distress , Gestational Age , Incidence , Intensive Care, Neonatal , Linear Models , Maternal Age , Risk Factors , Umbilical ArteriesABSTRACT
OBJECTIVE: To investigate whether umbilical artery Doppler blood flow velocity waveform is effective in predicting perinatal outcome of term pregnancies with small for gestational age (SGA). METHODS: A total of 381 patients at 37~41 weeks of gestational age (GA) who received antenatal umbilical artery Doppler blood flow test and delivered singleton SGA infants. The ratio of peak-systolic to end-diastolic (S/D) blood flow velocities in the umbilical artery was measured in each patient. The patients were divided into a normal group (n=307) with a S/D ratio equal to or less than 3.0, and an abnormal group with a S/D ratio of greater than 3.0 (n=74). These groups were comparatively analysed with respect to maternal characteristics and neonatal outcomes. Results: There were no significant differences between the two groups in mean maternal age, gestational age at the time of delivery, and cesarean section rate due to fetal distress. There was significantly increased incidence of hypertensive disorders in pregnancy in the abnormal S/D ratio group. And the abnormal S/D ratio group showed lower neonatal birthweight, higher incidence of admission to neonatal intensive care unit (NICU), and longer stay in neonatal intensive care unit. According to linear regression, in pregnancies complicated by SGA, abnormal S/D ratio was still a risk factor for low birthweight even after controlling for the incidence of hypertension. Conclusion: In term pregnancies accompanied by SGA, abnormal umbilical artery S/D ratio is an independent predictor of neonatal birth weight, incidence of admission to NICU, and NICU stay.
Subject(s)
Humans , Infant , Infant, Newborn , Pregnancy , Blood Flow Velocity , Fetal Distress , Gestational Age , Incidence , Intensive Care, Neonatal , Linear Models , Maternal Age , Risk Factors , Umbilical ArteriesABSTRACT
Objective To explore the effect of umbilical artery blood pH on the diagnosis of neonatal asphyxia and the evaluation of its prognosis. Methods Blood samples were obtained from 108 normal newborns and 51 asphyxial newborns,who were randomly chosen among newborns delivered in our hospital from november 2007 to may 2008. Umbilical artery blood gas was measured and compared with apgur rating. Results With the degression of umbilical blood pH, the incidence rate of neonatal asphyxia increased and the normal apgar rating decreased(P < 0.01), which suggesting that there was tight relevant between umbilical blood pH and neonatal asphyxia. Conclusion Compared with apgur rating, umbilical artery blood pH could reflect the asphyxia degree of newborns more objectively andsensitively and it might play a guiding role in the prognosis of neonatal asphyxia.
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OBJECTIVE: The purpose of this study was to compare the umbilical artery blood gas analysis and assess the relationship between fetal oxygenation and placenta to birth weight ratios in preeclampsia and small for gestational age. METHODS: We compared the results of umbilical artery blood gas analysis and placenta to birth weight ratio in group of preeclampsia (N=28), group of small for gestational age (N=15), group of large for gestational age (N=15), and controls (N=24). And we also divided all of them into 3 groups by placenta to birth weight ratio at birth, 0.25 (N=18). We compared umbilical artery gas analysis in each groups. RESULTS: The placenta to birth weight ratio in PE was significantly lower than control group (p<0.05). Umbilical artery pO2 and O2 saturations in each group of preeclampsia and small for gestational age were significantly lower than group of large for gestational age and controls (p<0.05). But we could not find any differences in other umbilical artery blood gas analysis (pH, pCO2, HCO3-). Umbilical artery pO2 and O2 saturations of higher placenta to birth weight ratio were stepwise lower than those of lower placenta to birth weight ratio but, pCO2 of higher placenta to birth weight ratio was stepwise lower than those of lower placenta to birth weight ratio. But there was no significant difference. CONCLUSION: Our data suggested that fetal oxygenation is significant determinant of fetal growth from small for gestational age and preeclampsia. And it may be related to placental implantaton and growth.