391 Midwife guidance has a beneficial effect on umbilical cord blood sampling quality

Abstract

Umbilical cord arterial blood gas analysis is important for neonatal assessment at birth, particularly for asphyxia determination. It is strongly advocated to obtain samples from both artery and vein to ensure the biological validity of values obtained. Inadequate sampling may lead to the misdiagnosis of birth asphyxia resulting in insufficient treatment. Our objective was to evaluate the effect of midwife guidance on the quality of umbilical blood sampling and the rate of inadequate results. This retrospective interventional cohort study included all women admitted to the delivery room who had a postpartum umbilical cord blood sampling. A comparison was made between blood gas results of women who gave birth in the year preceding and the year following a midwife guidance about proper sampling (which took place on April 2019). Clinical characteristics were compared between the groups of adequate and inadequate sampling. Umbilical cord sampling was considered adequate if two measurements were recorded with a veno-arterial pH gradient of at least 0.02 and an arterio-venous pCO2 gradient of no less than 0.5 kPa. Overall, 3,779 women gave birth in the year preceding the midwife guidance, and 3,649 in the subsequent year. Of these, 1,112 (29.4%) and 1,105 (30.2%) underwent umbilical sampling. Demographic and obstetric characteristics did not differ between the two groups. In the year following the guidance, 750 (67.8%) adequate samples were drawn compared to 692 (62.2%) in the year before, demonstrating a significant improvement (Odds Ratio 1.28, 95% confidence interval 1.07 to 1.52, P=0.006). Parameters associated with inadequate sampling were lower gestational age, primigravity, lower newborn weight, vaginal birth and vacuum deliveries. The quality of umbilical blood cord results was enhanced following simple midwife guidance on correct sampling. Labor wards should consider carrying out annual demonstrations of proper drawing umbilical blood collection, with an emphasis on factors which could possibly affect the sampling.View Large Image Figure ViewerDownload Hi-res image Download (PPT)