Abstract
Background: Perinatal asphyxia is a significant contributing factor for neonatal morbidity and mortality. The aim of this study was to investigate the clinical factors associated with umbilical artery pH variability and fetal acidosis at birth.Methods: This is a single center cross-sectional study in a public regional hospital in southeastern Spain from January to December 2019. The reference population was 1.655 newborns, final sample of 312 experimental units with validated values of umbilical cord blood pH.Results: Factors such as gestational age at term (: 7.26 ± 0.08--at−term: 7.31 ± 0.05, p: 0.00), primiparity (: 7.24 ± 0.078-: 7.27 ± 0.08, p: 0.01), induced labor (: 7.24 ± 0.07-: 7.26 ± 0.081, p: 0.02), vaginal delivery (:7.25 ± 0.08-:7.27 ± 0.07, p: 0.01), and prolonged dilation duration (: 7.22 ± 0.07-: 7.27 ± 0.08, p: 0.00), expulsion duration (: 7.23 ± 0.07-: 7.26 ± 0.08, p: 0.01), and total labor duration (: 7.23 ± 0.07-: 7.27 ± 0.08, p: 0.00) are associated with a decrease in umbilical artery pH at birth. However, only three factors are associated with acidosis pH (<7.20) of the umbilical artery at birth: the induction of labor [OR: 1.74 (95% CI: 0.98–3.10); p: 0.04], vaginal delivery [OR: 2.09 (95% CI: 0.95–4.61); p: 0.04], and total duration of labor [OR: 2.06 (95% CI: 1.18–3.57); p: 0.01].Conclusions: Although several factors may affect the variability of umbilical artery pH at birth by decreasing their mean values (gestational age, primiparity, induced labor, vaginal delivery and prolonged: dilation duration, expulsion duration and total labor duration), only induction of labor, vaginal delivery and total duration of labor are associated with an acidosis (<7.20) of same.
Highlights
The term asphyxia can be defined as an alteration in gas exchange that leads to progressive hypoxia, hypercapnia, and acidosis [1]
The results do not show significant differences according to reasons for induction [F(6): 0.74, p: 0.61], despite the fact that the lowest mean values of umbilical artery pH are found in births whose induction was retarded intrauterine growth (IUGR) (X : 7.20 ± 0.06), followed by a risk of loss of fetal well-being (RLFW) (X : 7.22 ± 0.06), prolonged pregnancy (PP) (X : 7.23 ± 0.07), premature rupture of membranes (PROM) (X : 7.24 ± 0.08), oligohydramnios (X : 7.24 ± 0.07), maternal disease unrelated to the pregnancy (X : 7.26 ± 0.07), and pregnancyinduced hypertension (PIH) (X : 7.29 ± 0.06)
Regarding the type of completion of delivery, a significant association was observed with respect to the decrease in the mean values of the umbilical artery pH in instrumented delivery compared with elective cesarean section (Xinstrumented: 7.24 ± 0.07∼Xcesarean: 7.29 ± 0.06; t(100):−3.92, p:0.00), an association that is not found in other types of delivery such as eutocic delivery(Xinstrumented: 7.24 ±
Summary
The term asphyxia can be defined as an alteration in gas exchange that leads to progressive hypoxia, hypercapnia, and acidosis [1]. Mortality and morbidity associated with intrapartum hypoxia persists as a global health problem [3], being one of the main causes of neonatal mortality in the first 24 h [4]. Neonatal asphyxia alters the passage from intrauterine to extrauterine life, a transit that requires well-orchestrated measures to ensure neonatal survival [6]. In this sense, the analysis of the acid–base balance of the umbilical artery blood at birth is an objective way to evaluate the metabolic state of the newborn, noting the presence or absence of neonatal asphyxia [7], a measure that is internationally accepted as a criterion for defining intrapartum hypoxia [8]. The aim of this study was to investigate the clinical factors associated with umbilical artery pH variability and fetal acidosis at birth
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