1. To assess the accuracy of umbilical cord blood
* Fisher’s Exact Test (LR) ** Chi-Square (LR) [Categories: Breech+Forceps/Normal/Vaccum] *** t-Test (unequal variances)
**** Wilcoxon ***** Upper is t-Test (unequal variances) & Lower is Wilcoxon
2- White, Christopher R. H.; Doherty, Dorota A.; Henderson, Jennifer J.; Kohan, Rolland; Newnham, John P.; Pennell, Craig E. Benefits of Introducing Universal Umbilical Cord Blood Gas and Lactate Analysis Into an Obstetric Unit Obstetrical & Gynecological Survey: January Volume 66 - Issue 1 - pp 14-15
8-Jóźwik M, Jóźwik M, Niemiec KT, Sledziewski A, Bojaryn U, Jóźwik M .Acid-base balance and umbilical blood gases in neonates born at term in North-Eastern region of Poland]. .Med Wieku Rozwoj Oct-Dec;10(4):
8-Jóźwik M, Jóźwik M, Niemiec KT, Sledziewski A, Bojaryn U, Jóźwik M .Acid-base balance and umbilical blood gases in neonates born at term in North-Eastern region of Poland]. .Med Wieku Rozwoj Oct-Dec;10(4):
9-Armstrong L, Stenson B. Effect of delayed sampling on umbilical cord arterial and venous lactate and blood gases in clamped and unclamped vessels. Arch Dis Child Fetal Neonatal Ed 2006; 91:F342.
10-Lievaart M, de Jong PA. Acid-base equilibrium in umbilical cord blood and time of cord clamping. Obstet Gynecol 1984; 63:44.
11-Wiberg N, Källén K, Olofsson P. Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations. BJOG 2008; 115:697.
8-Jóźwik M, Jóźwik M, Niemiec KT, Sledziewski A, Bojaryn U, Jóźwik M .Acid-base balance and umbilical blood gases in neonates born at term in North-Eastern region of Poland]. .Med Wieku Rozwoj Oct-Dec;10(4):
9-Armstrong L, Stenson B. Effect of delayed sampling on umbilical cord arterial and venous lactate and blood gases in clamped and unclamped vessels. Arch Dis Child Fetal Neonatal Ed 2006; 91:F342.
10-Lievaart M, de Jong PA. Acid-base equilibrium in umbilical cord blood and time of cord clamping. Obstet Gynecol 1984; 63:44.
11-Wiberg N, Källén K, Olofsson P. Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations. BJOG 2008; 115:697.
8-Jóźwik M, Jóźwik M, Niemiec KT, Sledziewski A, Bojaryn U, Jóźwik M .Acid-base balance and umbilical blood gases in neonates born at term in North-Eastern region of Poland]. .Med Wieku Rozwoj Oct-Dec;10(4):
9-Armstrong L, Stenson B. Effect of delayed sampling on umbilical cord arterial and venous lactate and blood gases in clamped and unclamped vessels. Arch Dis Child Fetal Neonatal Ed 2006; 91:F342.
10-Lievaart M, de Jong PA. Acid-base equilibrium in umbilical cord blood and time of cord clamping. Obstet Gynecol 1984; 63:44.
11-Wiberg N, Källén K, Olofsson P. Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations. BJOG 2008; 115:697.
To assess the accuracy of umbilical cord blood
gas in determining severity of newborn condition
B Al Kordi , N Nimeri, S Alomer ,B Greer
1 Division of Neonatology. Department of Pediatrics
2 Department of Obstetrics, Gynecology
Hamad medical corporation Doha , QATAR
ABSTRACT
DESCRIPTIVES (TOTAL POPULATION: N=1057)
QATARI
NON-QATARI N p
GRAVIDA (1/>1)*
Proportion = 0.70
Proportion = 0.59
1,052
0.0005
PARITY (0/>0)*
Proportion = 0.65
Proportion = 0.53
0.0003
ABORTION(0/>0)*
Proportion = 0.21
Proportion =0.18
0.2189
DELIVERY**
Proportions = 0.01 / 0.80 / 0.19
Proportions = 0.02 / 0.74 / 0.25
1,057
0.0646
BIRTHWEIGHT***
Mean = 3.17 (SE=0.034)
Mean = 3.21 (SE=0.217)
0.2811
GESTAGE****
Mean = (SE=0.136)
Mean = (SE=0.086)
1,053
0.5350
APH*****
Mean = (SD=0.082)
Mean = (SD=0.090)
1,039
0.0021
0.0037
ABE*****
Mean = (SD=2.481)
Mean = (SD=x2.725)
1,019
<0.0001
VPH*****
Mean = (SD=0.078)
Mean = (SD=0.089)
874
0.0058
0.0117
VBE*****
Mean = (SD=2.205)
Mean = (SD=2.674)
856
0.0002
APGAR1MIN (<=6/>=7)*
Proportion =
Proportion =
1.0000
APGAR5MIN (<=6/>=7)*
Proportion =
Proportion =
1,054
0.7200
ADMITNICU*
Proportion =
Proportion =
0.7126
Current data suggest that umbilical arterial pH analysis is the most sensitive diagnostic indicator of birth asphyxia. Essential criteria for the diagnosis of birth asphyxia include metabolic acidosis (pH <7.0 and base deficit ≥12 mmol/L) in cord arterial blood[1].
Introduction:
.Umbilical cord blood gas and acid-base assessments are the most objective determinations of the fetal metabolic condition at the moment of birth.. We conducted this study to assess how accurate the umbilical cord gas parameters are in determining the outcome of the new born
.The most recent American College of Obstetricians and Gynecologists Committee Opinion(#348) states, “Physicians should obtain arterial and venous cord gases in the following situations; Cesarean delivery for fetal compromise, low 5 minute Apgar, severe growth retardation, abnormal fetal heart rate tracing, maternal thyroid disease, intrapartum fever, multifetal gestation
.Acidosis observed in infants in the neonatal period can be the cause of many disturbances in adaptation to extra uterine life. In the literature various values of acid-base balance and umbilical blood gases parameters are quoted as borderline between normal and pathological [2].
Background :
Method:
The cord gas data of all high-risk deliveries during 2013 in the Women‘s Hospital of Hamad Medical Corporation Qatar were collected. Maternal Data include parity, illness, nationality, together with the indication of cord gas sampling were gathered. Neonatal data includes gestational age weight combined with the Apgar score. The outcome of both the mother and new born was recorded.
The proper way to collect a cord sample is as follows: a 10 to 20 cm segment of umbilical cord is doubly clamped as soon as possible after delivery [9] because delay in clamping may significantly affect pH and gas values as a result of gaseous diffusion and continuing metabolism [3-4]. Blood is drawn from the umbilical artery into a 1 to 2 mL syringe, which has been flushed with heparin, and the syringe is immediately transported on ice to the laboratory
Conclusion:
The cord gas is significantly correlating more with the baby Apgar score at one minute rather than 5 minutes. The outcome is affected by the severity of the cord gas
References:
Results:
1- White, Christopher R. H.; Doherty, Dorota A.; Henderson, Jennifer J.; Kohan, Rolland; Newnham, John P.; Pennell, Craig E. Benefits of Introducing Universal Umbilical Cord Blood Gas and Lactate Analysis Into an Obstetric Unit Obstetrical & Gynecological Survey: January Volume 66 - Issue 1 - pp 14-15
2-Jóźwik M, Jóźwik M, Niemiec KT, Sledziewski A
Bojaryn U, Jóźwik M.Acid-base balance and umbilical blood gases in neonates born at term in North-Eastern region of Poland]. .Med Wieku Rozwoj Oct-Dec;10(4):
3-Armstrong L, Stenson B. Effect of delayed sampling on umbilical cord arterial and venous lactate and blood gases in clamped and unclamped vessels. Arch Dis Child Fetal Neonatal Ed 2006; 91:F342.
4-Wiberg N, Källén K, Olofsson P. Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations. BJOG 2008; 115:697.
A total number of deliveries during the study period were 15,000 cases. Of these high-risk deliveries, cord sampling was carried out in 1042 cases. When combining all elements of cord gas done, the percentage of severe cases was 15.3% with 11% of these babies needs NICU admission. Babies with cord PH <6 were having Apgar score <7 at 1 minute of age (P=0.0002) while no significant association with Apgar at 5 minutes of age. The worse the PH is more likely the baby will be admitted to NICU (P=0.0203)