Umbilical cord blood gas analysis, obstetric performance and perinatal outcome / Gasometria do cordão umbilical, atuação obstétrica e desfecho neonatal

Abstract Objective To analyze if umbilical artery pH (pHua) ≤7.00 and umbilical artery blood deficit (BDua) ≥12.00 mmol/L are good predictors of adverse neonatal outcomes. Methods This was an observational, longitudinal and retrospective cohort study, conducted at the department of obstetrics and gynecology of Centro Hospitalar Tondela Viseu between September 2013 and September 2015. Total cohort and subgroup analysis were performed: group A-women with umbilical cord blood gas analysis (UCBGA) performed for non-reassuring fetal cardiotocographic patterns, placental abruption, or shoulder dystocia; and group B-all the others. Assays were made with the software SPSS for Windows, Versions 20.0 and 21.0 (IBM Corp., Armonk, NY, USA). Results A total of 428 UCBGAs met the inclusion criteria. The group analysis revealed an association between group A and pHua ≤7.00, as well as between BDua ≥12.00 mmol/L and 1st minute Apgar score ≤4 (p = 0.011). After the application of the logistic regression models in the total cohort analysis, pHua ≤7.00 had an impact in the occurrence of acute neonatal hypoxia (odds ratio [OR]: 6.71; 95% confidence interval [CI]: 1.21-37.06; p = 0.029); multiparous women had a higher risk of delivering a newborn with first minute Apgar score ≤4 and acute neonatal hypoxia (OR: 5.38; 95% CI: 1.35-21.43; p = 0.017; and OR: 2.66; 95% CI: 1.03-6.89, p = 0.043, respectively); women who had urologic problems during pregnancy had a higher risk of delivering a newborn with 5th minute Apgar score ≤7 (OR: 15.17; 95% CI: 1.29-177.99; p = 0.030); and shoulder dystocia represented a 15 times higher risk of acute neonatal hypoxia (OR: 14.82; 95% CI: 2.20-99.60; p = 0.006). Conclusion The pHua and the BDua are predictors of adverse neonatal outcome, and UCBGA is a useful tool for screening newborns at risk. Universal UCBGA should be considered for all deliveries, as it is an accurate screening test for neonatal hypoxia.

Resumo Objetivo Avaliar se o pH da artéria umbilical (pHua) ≤7,00 e o déficit de bases da artéria umbilical (BDua) ≥12,00 mmol/L são preditores de desfechos neonatais adversos. Métodos Estudo observacional, longitudinal e retrospectivo, realizado no Serviço de Ginecolocgia e Obstetrícia do Centro Hospitalar Tondela Viseu durante o período de setembro de 2013 a setembro de 2015. Foi realizada a análise de toda a coorte e de dois subgrupos: grupo A-mulheres cuja gasometria do cordão umbilical (UCBGA, na sigla em inglês) foi realizada por traçado cardiotocográfico não tranquilizador, descolamento prematuro de placenta normalmente inserida, ou distócia de ombros; e grupo B -todas as outras. A análise estatística foi realizada com o programa SPSS for Windows, Versões 20.0 e 21.0 (IBM Corp., Armonk, NY, USA) Resultados Um total de 428 UCBGAs cumpriram os critérios de inclusão. A análise de grupo revelou uma associação entre o grupo A e pHua ≤7,00 (p = 0,002), e entre BDua ≥12,00 mmol/L e índice de Apgar ao 1o minuto ≤4 (p = 0,011). Após a aplicação dos modelos de regressão logística na análise da coorte total, pHua ≤7.00 teve impacto na ocorrência de hipóxia neonatal aguda (razão de probabilidade [RP]: 6,71; 95% índice de confiança [IC]: 1,21-37,06; p = 0,029); verificou-se maior risco de recém-nascido com índice de Apgar ao 1o minuto ≤4 e hipóxia neonatal aguda nas multíparas (RP: 5,38; 95% IC: 1,35-21,.43; p = 0,017; e RP: 2,66; 95% IC: 1,03-6,89; p = 0,043, respectivamente); e de recém-nascido com índice de Apgar ao quinto minuto ≤7 nas mulheres com problemas urológicos na gravidez (RP: 15,17; 95% IC: 1,29-177,99; p = 0,030); e a ocorrência de distócia de ombros aumentou 15 vezes o risco de hipóxia neonatal aguda (RP: 14,82; 95% IC: 2,20-99,60; p = 0,006). Conclusão OpHua e o BDua são preditores de desfecho neonatal adverso, e a UCBGA é uma ferramenta útil no rastreio dos recém-nascidos em risco. A realização universal de UCBGA deve ser considerada emtodos os partos, visto ser umteste de rastreio objetivo de hipóxia neonatal.

Gas analysis of umbilical cord artery blood on predicating the prognosis of asphyxia neonate / 中国综合临床

Objective To study the gas analysis of umbilical cord artery blood and radial artery blood on predicating the prognosis of asphyxia neonate?Methods From September 2014 to September 2015, 328 neonates were divided into groups by Apgar score:290 patients in the control group and 27 patients in the mild asphyxia group,11 patients in the severe asphyxia group?After birth,umbilical artery blood,radial artery blood gas analysis was perfomed, oxygenation index was calculated, Outcome of neonatal behavioral neurological assessment ( NBNA) in neonates with asphyxia was regular follow?uped,the relationship between pH value and umbilical artery blood gas analysis was analyzed?Results The pH, PO2, PCO2 and oxygenation index of umbilical cord blood and radial artery blood in the severe asphyxia group was(7?11±0?25,(73?93±23?35) mmHg,(51?36±16?37) mmHg,206?23±98?12),significant different than the mild group(7?24±0?05,(86?35 ±12?56) mmHg,(45?89± 9?21) mmHg,411?22±57?94) and the control group(7?28±0?08,(87?80±12?07) mmHg,(43?68± 6?45) mmHg,426?23±73?30)(P<0?05)?The pH,PO2,PCO2 and oxygenation index of umbilical cord blood and radial artery blood in the severe asphyxia group was(7?25±0?18,(74?66±24?09) mmHg,(51?42±17?83) mmHg,332?03±65?19),significant different than the mild group(7?31±0?09,(87?24 ±11?75) mmHg,(45?73±10?21) mmHg,405?67±82?65) and the control group(7?32±0?06,(87?99±11?81) mmHg,(42?84± 9?32) mmHg,439?89±60?76)(P<0?05)?The NBNA scores of the severe asphyxia group was (34?09±5?02) points,lower than the mild group(36?62±2?04)(F=21?65,P<0?05)?The NBNA scores showed significant relationship with umbilical cord blood pH in the severe asphyxia group( r=0?877,P<0?01)?Conclusion The pH,PO2 and oxygenation index of umbilical cord blood and radial artery blood was lower while PCO2 was markedly high in the severe asphyxia group than other groups?For neonates, there is a correlation between umbilical cord blood pH and NBNAs core, neonates borned with hypoxia and acidosis should monitor blood gas analysis and oxygenation index dynamically

The Clinical Significance of Apgar Score and Umbilical Arterial Blood Gas Analysis on Preterm Infant Delivered Vaginally / 대한산부인과학회잡지

OBJECTIVE: The Apgar score has long been used to determining birth asphyxia and assessing early neonatal status and long-term outcome. Unfortunately, some components of this system depend upon subjective interpretation. Also, although, low Apgar score, Most of newborns are relatively healthy. The objective of our studt is attempt to assure the linical significance of Apgar score and umbilical cord blood gas analysis on assessing status of uncomplicated preterm infants delivered vaginally. METHODS: The present study was performed in attempt to compare umbilical arterial blood gas values for uncomplicated preterm infants delivered vaginally with low 1 and 5 minutes Apgar score (7), each other, The present study included 82 uncomplicated term infants delivered vaginally and 24 preterm infants. Inclusion criteria of our study is as follows: 1) Singleton neonate with vertex presentation, 2) No congenital malformation, 3) Infants whose mother had no obstetrical and medical complications, 4) Immediately after delivery, umbilical arterial blood was sampled, before first breathing of neonate, 5) Infants applied Apgar score at I minute and again 5 minutes after birth, and 6) Infants whose mothers gestational age was estimated by ultrasonography during first-trimester of pregnancy. The statistical analysis was performed by Mann-Whitney U test and Fishers exact test. RESULTS: 1) There was no significant difference in umbilical arterial blood gas values between uncomplicated preterm infants delivered vaginally with low 1 and 5 minutes Apgar score (7). 2) There was no significant difference in umbilical arterial blood gas values between uncomplicated preterm infants delivered vaginally with low 1 and 5 minutes Apgar score (7). 3) There was significant difference in frequency of lower Apgar score (<7) between term (2%[2/82]) and preterm infants (38%[9/24]), but not in frequency of acidemia (defined as less than pH 7.2) (28%[23/82] Vs 33%[8/24]). CONCLUSION: The Apgar score is not a reliable indieator of well-being in preterm neonate. We recommend umbilical arterial blood sampling at delivery of preterm infant with low Apgar score, because umbilical cord blood gas indices on objective means of assessing birth status of the newbarn and more useful than Apgar score in ruling out birth asphyxia.