Cord Blood Acid-base Status Research Articles

Взаимосвязь кислотно-основного состава пуповинной крови с развитием гипоксически-ишемической энцефалопатии у новорожденного

Взаимосвязь кислотно-основного состава пуповинной крови с развитием гипоксически-ишемической энцефалопатии у новорожденного

Определение кислотно-основного состояния пуповинной крови. Показания и техника

Определение кислотно-основного состояния пуповинной крови. Показания и техника

Assessment of fetal cord blood acid-base status following intrapartum maternal glucose infusion

Background and Aim: Supplementation of intravenous fluids is associated with with increased incidence of neonatal hypoglycemia. However, WHO guideline recommends no restriction of liquid or solid food to a parturient mother. Therefore, the aim of the study is to compare fetal acid-base status and neonatal blood glucose levels following intrapartum infusion of ringer lactate (RL) solution or dextrose normal saline (DNS) solution in active labor. Methods: It is a prospective, analytical study conducted on hundred women in active labor and they were randomly allocated into two groups. First group (Group A) received intravenous infusion of DNS, and the other group (Group B) was given RL infusion for at least 1 h before delivery. Results: There was no significant difference in fetal acid-base status between the two groups although neonatal blood glucose levels were higher in the DNS group (Group A). Conclusion: Intrapartum infusion of DNS can raise neonatal blood glucose level but does not cause fetal acidosis or any alteration in fetal acid-base status.

Umbilical cord blood acid-base status in pregnancy with congenital heart disease.

The risk of fetal and neonatal complications is higher in pregnant women with congenital heart disease (CHD). It remains unknown whether umbilical cord blood gas values are different between pregnant women with CHD and healthy women undergoing elective cesarean section during combined spinal-epidural anesthesia. The purpose of the present study was to compare umbilical cord blood acid-base status and gas values in pregnant women with CHD vs. healthy pregnant women undergoing elective cesarean section during combined spinal-epidural (CSE) anesthesia. Patients with singleton pregnancy undergoing elective cesarean delivery under CSE anesthesia were enrolled. Patients were divided into two groups: healthy pregnant women (group H) and pregnant with congenital heart disease (group CHD). Immediately after delivery, umbilical cord arterial blood sample and venous blood sample were collected and measured. The comparison between two groups was performed using grouped t-test. Forty-four women in group H and 33 women in group CHD were analyzed finally. Umbilical arterial blood pH, base excess (BE) and HCO3 (-) (pH 7.29 ± 0.05, BE -1.4 ± 1.9 mmol/L, HCO3 (-) 21.5 ± 1.4 mmol/L) were significantly lower in pregnant women with CHD than in healthy pregnant women (pH 7.33 ± 0.03, BE -0.1 ± 2.1 mmol/L, HCO3 (-) 22.5 ± 1.4 mmol/L). The lower values of umbilical arterial blood pH, BE and HCO3 (-) were observed in pregnant women with CHD than in healthy women undergoing elective cesarean section during CSE anesthesia.

The value of epidural magnesium sulfate as an adjuvant to bupivacaine and fentanyl for labor analgesia

ObjectiveWe conducted this clinical study to assess the adjuvant effects of single dose magnesium sulfate (Mg) when administered epidurally during labor with fentanyl and bupivacaine.MethodsEighty healthy nulliparous women in labor requesting epidural analgesia were divided into two groups. Group 1 received bupivacaine 0.125% with magnesium sulfate 50 mg and fentanyl 50 μg as a loading dose; group 2, received bupivacaine 0.125% and fentanyl 50 μg only. Hemodynamic parameters, motor and sensory evaluation, cervical dilation at time of consenting, the progress of labor, the visual analog pain score (VAS), Apgar score, cord blood acid base status, side effects as nausea, vomiting, itching and respiratory depression were recorded. Fetal heart rate tracings were also documented.ResultsEpidural single dose magnesium sulfate added to bupivacaine and fentanyl in labor resulted in significantly faster onset and longer duration of epidural analgesia (169 ± 50 min) in comparison to those patients who received bupivacaine and fentanyl only (105 ± 41 min), also there was a significant reduction in the number of women requiring additional boluses of bupivacaine when Mg was added (P = 0.016). The two groups had no significant differences as regards maternal satisfaction score, maternal and neonatal adverse effects.ConclusionMagnesium sulfate added to bupivacaine and fentanyl for labor epidural analgesia resulted in faster onset, longer duration of action and reduced the break through pain.

SP6-28 Effect of umbilical cord blood acid-base status and gas values on the yield of mononuclear cells and cd34 cells

PurposeTo investigate the influence of umbilical cord blood (CB) acid-base status and gas values on the yield of mononuclear cells and CD34 cells, pH, pCO2, pO2, HCO3− and base excess...

Cord blood acid-base status at delivery after successful external cephalic version.

This study was designed to evaluate whether cord blood acidosis is more likely in infants born after successful external cephalic version. This retrospective cohort study included 89 singleton deliveries with successful version performed over a 2-year period. Their cord blood acid-base parameters were compared to 89 pregnancies with spontaneous cephalic presentation (control group). There was no significant difference between the version and control groups in birthweight and Apgar scores. There was no difference between the version and control groups in cord arterial pH (7.26 vs. 7.26), arterial pCO(2) (7.04 vs. 7.09 kPa), arterial pO(2) (2.34 vs. 2.59 kPa), arterial base excess (-5.59 vs. -5.64 mmol/L), venous pH (7.32 vs. 7.33), venous pCO(2) (5.73 vs. 5.63 kPa), venous pO(2) (3.86 vs. 3.84 kPa), or venous base excess (-5.03 vs. -5.12 mmol/L). There was also no significant difference in the number of fetuses with cord arterial pH <7.20 between the two groups. Neonates delivered after successful external cephalic version are not more likely to be born with acidosis. Our study provides further support for the safety of external cephalic version for term breech pregnancies.

Cord blood acid-base status at delivery after successful external cephalic version

Cord blood acid-base status at delivery after successful external cephalic version

Vaginal breech delivery: is it still an option?

Objective: To provide local data on term breech delivery for future guidance. Study design: Retrospective, ‘intended-mode-of-delivery’ analysis of 711 antenatally uncomplicated singleton breech deliveries at ≥37 weeks: 445 (63%) planned for vaginal delivery (VD) (no fetal growth restriction, fetal weight 2000–4000 g, adequate pelvic size, maternal consent) and 266 for cesarean section (CS). Outcome measures: Apgar score, cord blood acid–base status, childhood deaths and disability. Results: Perinatal mortality was nil in both groups. Low 1-min Apgar scores and low arterial cord blood pH were significantly more frequent in planned VD, but not low Apgar scores at 5 or 10 min or low venous pH. Metabolic acidosis, neonatal intensive care, neonatal seizures, birth trauma, childhood death (CS=1), and neurodevelopmental handicaps (CS=2, VD=1) were equally common. Conclusion: Our results do not disqualify selective vaginal breech delivery at term and beyond as an option.

Lipid peroxidation in umbilical arterial blood at birth: the effects of breech delivery.

To determine oxygen free radical activity in breech presentation at birth and relate it to umbilical cord blood acid-base status. A series of 63 singleton deliveries (28 cephalic deliveries as controls), 23 breech deliveries with normoacidemia, and 12 breech deliveries with mild acidaemia) had determination of malondialdehyde and acid-base parameters. The delivery suite in the Department of Obstetrics and Gynaecology at the Süleyman Demirel University, Isparta, Turkey. Sixty-three singleton infants born at term with spontaneous or induced labour and initially normal fetal heart rate tracing. After delivery, umbilical cord arterial and venous blood samples were collected for the determination of malondialdehyde concentrations. Oxygen saturation, pO2, pCO2, pH, and base excess were also measured. Umbilical cord arterial and venous blood gases and malondialdehyde levels. There was a significant correlation between umbilical arterial and venous levels of malondialdehyde and all acid-base parameters (P < 0.001). There were negative correlations between malondialdehyde levels and pH, pO2 and bicarbonate, while there was a positive correlation between malondialdehyde concentrations and pCO2. A positive correlation between malondialdehyde levels and base excess was present in the control group and total breech group (n = 35). The malondialdehyde levels in the total breech group, nonacidaemic breech group (n = 23) and the mildly acidaemic breech group (n = 12) were significantly higher than those in the control group (P < 0.0001). However, acid-base parameters in the nonacidaemic breech group were not statistically different from those in the control group. Lipid peroxidation products (malondialdehyde) existed to some extent in the umbilical cords of newborns with normal acid-base parameters in breech delivery. Our data support the contention that lipid peroxide may be a more sensitive measure for metabolic dysfunctions due to fetal hypoxia than acid-base balance.

The association between oxidative stress and umbilical cord blood acid-base status during delivery

International Journal of Gynecology & ObstetricsVolume 70, Issue S2 p. B121-B121 Fetal monitoring/programming The association between oxidative stress and umbilical cord blood acid-base status during delivery A. Bobakova, A. BobakovaSearch for more papers by this authorM. Simko, M. SimkoSearch for more papers by this authorP. Blazicek, P. BlazicekSearch for more papers by this authorI. Holly, I. HollySearch for more papers by this authorD. Syrova, D. SyrovaSearch for more papers by this author A. Bobakova, A. BobakovaSearch for more papers by this authorM. Simko, M. SimkoSearch for more papers by this authorP. Blazicek, P. BlazicekSearch for more papers by this authorI. Holly, I. HollySearch for more papers by this authorD. Syrova, D. SyrovaSearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)83077-5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS22000Pages B121-B121 RelatedInformation

Umbilical cord blood gas analysis in augmented labour

Labour augmentation with oxytocin may produce an excessive increase in frequency, duration or strength in uterine contractions which may result in fetal stress. Umbilical cord acid-base assessment provides an objective parameter in evaluating the neonatal condition immediately after delivery. We evaluated the neonatal condition in 235 deliveries where oxytocin was used for labour augmentation. The umbilical cord blood acid-base status was correlated with intrapartum cardiotocographic findings and Apgar scores. In two cases we noted umbilical artery pH <7.05 but the BDecF was not higher than 11 mmol/l and the 5-minute Apgar score was 8 in all cases. Our results indicate that the use of oxytocin for labour augmentation had no adverse effects on neonatal condition.

Fetal effects of prophylactic ephedrine and maternal hypotension during regional anesthesia for cesarean section

The purpose of this study was to evaluate the effects of a prophylactic intravenous bolus of ephedrine on the incidence and severity of maternal hypotension and on neonatal outcome. Term healthy parturients (n = 122) scheduled for elective repeat cesarean section under regional anesthesia were studied. Ninety-two women received 10 mg ephedrine as a prophylactic intravenous bolus prior to intrathecal epidural local anesthesia. Thirty parturients who served as controls did not receive prophylactic ephedrine. Maternal blood pressures, Apgar scores, and umbilical cord blood acid-base status were evaluated. Sixty-three of 92 women (69%) who received intravenous prophylactic ephedrine prior to regional anesthesia developed hypotension compared to 21 (70%) controls. The mean (+/- SD) lowest systolic blood pressure was similar in both groups (95.6 +/- 12.9 vs. 96 +/- 8.9 mmHg; P = 0.86). The mean (+/-SD) fetal pH was significantly lower with prophylactic ephedrine than controls (7.24 +/- 0.07 vs. 7.28 +/- 0.05; P = 0.001). The frequency of umbilical artery blood pH < 7.20 was 10.6% for the ephedrine group vs. 3.2% for controls (P = 0.024). Among newborns of hypotensive mothers, the frequency of umbilical artery blood pH < 7.20 was 30.2% and 4.6% for the ephedrine and control groups, respectively (P = 0.018). Intravenous prophylaxis with ephedrine did not significantly decrease the frequency of hypotension in women receiving regional anesthesia and resulted in a greater proportion of umbilical artery blood pH values < 7.20.

Lipid peroxidation in cord blood at birth

OBJECTIVE: The purpose of this study was to determine oxygen free radical activity in the neonate at birth and relate it to umbilical cord blood acid-base status. STUDY DESIGN: A series of 110 singleton deliveries had determination of two lipoperoxides in umbilical cord blood: malondialdehyde and organic hydroperoxide. Umbilical pH, PO 2, PCO 2, bicarbonate, and base excess were also measured. RESULTS: There was a significant association between lipoperoxides and cord blood pH and base excess. A significant difference existed in the levels of umbilical artery lipoperoxides between nonacidemic and acidemic fetus, as defined by an umbilical arterial pH <7.20. CONCLUSION: There is a positive association between lipoperoxide production and acid-base balance at delivery. (A M J O BSTET G YNECOL 1996;174:62-5.)

Fetal Effects of Prophylactic Ephedrine and Maternal Hypotension During Regional Anesthesia for Cesarean Section

The purpose of this study was to evaluate the effects of a prophylactic intravenous bolus of ephedrine on the incidence and severity of maternal hypotension and on neonatal outcome. Term healthy parturients (n = 122) scheduled for elective repeat cesarean section under regional anesthesia were studied. Ninety-two women received 10 mg ephedrine as a prophylactic intravenous bolus prior to intrathecal epidural local anesthesia. Thirty parturients who served as controls did not receive prophylactic ephedrine. Maternal blood pressures, Apgar scores, and umbilical cord blood acid-base status were evaluated. Sixty-three of 92 women (69%) who received intravenous prophylactic ephedrine prior to regional anesthesia developed hypotension compared to 21 (70%) controls. The mean (±SD) lowest systolic blood pressure was similar in both groups (95.6 ± 12.9 vs. 96 ± 8.9 mmHg; P = 0.86). The mean (±SD) fetal pH was significantly lower with prophylactic ephedrine than controls (7.24 ± 0.07 vs. 7.28 ± 0.05; P = 0.001). The frequency of umbilical artery blood pH < 7.20 was 10.6% for the ephedrine group vs. 3.2% for controls (P = 0.024). Among newborns of hypotensive mothers, the frequency of umbilical artery blood pH < 7.20 was 30.2% and 4.6% for the ephedrine and control groups, respectively (P = 0.018). Intravenous prophylaxis with ephedrine did not significantly decrease the frequency of hypotension in women receiving regional anesthesia and resulted in a greater proportion of umbilical artery blood pH values < 7.20.

Clinical evaluation of the fetus and neonate. Relation between intra-partum cardiotocography, Apgar score, cord blood acid-base status and neonatal morbidity.

The relation between intra-partum cardiotocography (CTG), cord blood acid-base status, Apgar score and neonatal morbidity was studied in 1228 consecutively live-born babies and in a subgroup of 200 babies (148 babies with a 1 min Apgar score < or = 8 and 52 randomly selected babies with a 1 min Apgar score > or = 9). The scores for the individual components of the 1 min Apgar score were strongly associated with each other, whereas the scores for the individual components of the 5 min Apgar score were less strongly associated. At 1 min the scores for muscle tone, reflex irritability and respiration but not the scores for heart rate and skin colour were associated with arterial and venous cord blood pH (low scores being associated with low pH). Out of the individual components of the Apgar score, heart rate and reflex irritability at 1 min were the best discriminators between "healthy or relatively healthy" and "severely ill" babies. Intrapartum CTG, total Apgar score and cord blood acid-base status were only weakly related. Venous cord blood pH was the best predictor of the 1 min Apgar score. Intra-partum CTG (silent pattern), 5 min Apgar score and venous cord blood pH were the best predictors of severe neonatal morbidity.

Response of Fetal Heart Rate to Scalp Stimulation Related to Fetal Acid-Base Status

The correlation of the response of the fetal heart rate (FHR) to scalp stimulation and the acid-base status of the fetal scalp blood (FSB pH) was studied in 104 term fetuses during labor. The mean FHR was determined for the 5-minute period before the preparation for fetal scalp blood pH determination and 1 minute following FSB pH. The analysis was performed for three pH groups: (a) Normal (pH more than 7.25, = 73); (2) preacidotic (pH 7.20 to 7.25, = 16); and (3) acidotic (pH less than 7.20, = 15). The pH was confirmed at delivery by determination of umbilical cord blood acid-base status. Regression analysis of the number of fetuses responding by changing their heart rate against time was significant only for the nonacidotic fetuses. There was no significant difference in the number of subjects whose mean FHR increased, decreased, or remained unchanged between the three pH groups. Furthermore, there was no difference between the three pH groups in the number of fetuses who demonstrated significant mean heart rate changes (p less than 0.05) following the stimulation compared to those who did not. Further analysis between fetuses in the three pH groups who increased FHR 15 beats/min or more following stimulation did not discriminate between groups. We conclude that scalp stimulation results in a FHR response in all three pH categories. However, the net change in the mean heart rate following the stimulation may be negative or positive. The magnitude and the direction of this change in FHR is not significantly related to FSB pH.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of sampling site and time upon umbilical cord blood acid-base status and PO2 in the newborn infant.

Measurement of umbilical cord blood acid-base status is routinely carried out in many obstetric centers. Umbilical cord blood pH, PO2, PCO2 and SBE (standard base excess) may change between clamping of the cord and analysis due to diffusion and metabolism. It was the aim of this study to evaluate these changes separately in artery and vein blood during storage in the clamped umbilical cord. The umbilical cords from 11 normal term deliveries were clamped immediately after delivery and kept at room temperature. Samples of artery and vein blood were drawned separately 1, 5, 10, 15 and 30 minutes post partum and pH, PO2 and PCO2 were measured and SBE calculated. As demonstrated in table I, the vein blood pH and PO2 values were higher and PCO2 values lower than in the artery blood. The changes over time are given in figure 1 with the 1 min values as points of reference. Changes within the first 15 minutes were modest. A significant fall in vein pH, vein SBE and artery PO2 and a significant rise in artery PCO2 was found. Greater variation in the changes over time was found in artery than in vein blood, being most evident for the 30 min values. Although significant changes in the umbilical cord acid-base values and PO2 do occur when the blood is stored in the clamped cord, we find these changes to be minor and we conclude that sampling can be postponed for up to 15 minutes after delivery.