The impact of introducing universal umbilical cord blood gas analysis and lactate measurement at delivery

Abstract

There is growing support for umbilical cord blood gas analysis (UCBGA) to be conducted at delivery. A recent study in a tertiary level obstetric unit found that universal UCBGA was associated with improved perinatal outcomes, but there is less evidence of benefit in lower-risk environments. In such settings, lactate analysis may be a suitable alternative. This study evaluated the introduction of universal UCBGA into a secondary obstetric unit and universal umbilical cord lactate analysis program into primary and secondary units. After education, universal UCBGA or lactate analysis was introduced into one primary and two secondary level obstetric units. Univariate and adjusted analysis assessed changes in UCBGA values and Apgar scores over the study period. There were no significant changes in mean blood gas and lactate values at any centre following introduction of universal UCBGA or lactate analysis. However, there was at the primary level obstetric unit a significant reduction in the proportion of neonates with moderate to severe elevations in umbilical artery lactate values. There was a non-significant reduction in arterial pH values less than 7.10 at the secondary metropolitan centre. The data presented in this study suggest that the benefits of introducing UCBGA into a tertiary obstetric centre may be reproduced in a primary obstetric centre within 12 months of implementation. Larger studies are required in secondary units to assess infrequent adverse obstetric and neonatal outcomes.