Cord Blood Gas Research Articles

Comparison of phenylephrine and norepinephrine for treatment of spinal hypotension during elective cesarean delivery- A randomised, double-blind study.

Hypotension following subarachnoid block for cesarean delivery (CD) is common. We compared the effect of bolus administration of norepinephrine and phenylephrine on umbilical artery pH (primary objective) and their efficacy for the treatment of maternal hypotension (secondary objective) in term parturients undergoing elective CD under spinal anesthesia. In a randomized, double-blinded study, parturients received 1 mL boluses of either phenylephrine 100 μg/mL (group phenylephrine; n = 45) or norepinephrine 7.5 μg/mL (group norepinephrine; n = 45) whenever maternal systolic blood pressure decreased to ≤80% of baseline. Maternal hemodynamic changes, vasopressor, and atropine requirement and neonatal outcome (umbilical cord blood gas analysis, Apgar scores, neonatal neurobehavioral response) were assessed. The Apgar scores and umbilical cord blood gas analysis were comparable between groups. The neurobehavioral scale score was significantly higher in group NE compared with that in group PE at 24 h and 48 h; P = 0.007 and 0.002, respectively. The number of vasopressor doses and time to the first vasopressor requirement for maintaining systolic pressure >80% of baseline was comparable in both groups. Incidence of bradycardia (P = 0.009), reactive hypertension (P = 0.003), and dose requirement of atropine (P = 0.005) was higher in group PE compared with group NE. In term normotensive parturients who received bolus norepinephrine 7.5 μg or phenylephrine 100 μg for the treatment of post-spinal hypotension during CD, neonatal umbilical cord blood gas analysis and Apgar scores were comparable. Norepinephrine use was associated with a lower incidence of maternal bradycardia and reactive hypertension compared with phenylephrine.

Delayed cord clamping: Impact on fetal cord blood gas analysis.

Both delayed cord clamping (DCC) and cord blood gas (CBG) analysis are recommended practices for preterm births. However, the compliance rates remain lower than expected, with a DCC rate of only 48.9% and CBG sampling of 66.6% in the preterm cohort. DCC was associated with a significant reduction in success rate of paired CBG analysis in both the term and preterm cohort of 8.3% and 7.7% respectively. Our study highlights the difficulty in achieving both recommendations.

An Unexpected Cause of Recurrent Fetal Decelerations

An Unexpected Cause of Recurrent Fetal Decelerations

Association of umbilical cord blood gas values with mortality and severe neurologic injury in preterm neonates

Umbilical cord arterial and venous blood gas values reflect the acid-base balance status of a newborn at birth. Derangement in these values has been linked to poor neonatal outcomes in term and late preterm neonates; however, the utility of these values in preterm neonates of <29 weeks' gestation is unclear. This study aimed to determine the associations of umbilical cord arterial and venous blood gas values with neonatal mortality and severe neurologic injury in extremely preterm neonates and to identify the cutoff values associated with 2.5-fold increases or decreases in the posttest probabilities of outcomes. This was a retrospective cohort study of neonates who were born at 23+0 to 28+6 weeks' gestation between January 1, 2018 and December 31, 2019, and who were admitted to neonatal units in Canada. Various cut-offs of umbilical cord blood gas values and lactate values were studied. The main outcomes were mortality before discharge from the neonatal unit and severe neurologic injury defined as grade 3 or 4 periventricular or intraventricular hemorrhage or periventricular leukomalacia. The outcome rates were calculated for various cutoff values of umbilical cord blood gas parameters and were adjusted for birthweight, gestational age, sex, and multiple births. Likelihood ratios were calculated to derive posttest probabilities. A total of 1040 and 1217 neonates had analyzable umbilical cord arterial and venous blood gas values, respectively. In the cohort, the mean (standard deviation) gestational age was 26.5 (1.5) weeks, the mean birthweight was 936 (215) g, the prevalence of mortality was 10% (105/1040), and the prevalence of severe neurologic injury was 9% (92/1016). An umbilical cord arterial pH of ≤7.1 and base excess of ≤-12 mmol/L were associated with >2.5-fold higher posttest probability of mortality, and an umbilical cord arterial or venous lactate value of <3 was associated with a 2.5-fold lower posttest probability of mortality. An umbilical cord arterial lactate value of <3 was associated with a lower posttest probability of severe neurological injury. In preterm neonates of <29 weeks' gestation, low umbilical cord arterial pH and high umbilical cord arterial base excess values were associated with a clinically important increase in the posttest probability of mortality, whereas low umbilical cord arterial or venous lactate values were associated with a decrease in the posttest probability of mortality.

The role of cord blood gas parameters in prediction of significant hyperbilirubinemia among healthy term newborns

The role of cord blood gas parameters in prediction of significant hyperbilirubinemia among healthy term newborns

Randomized trial of bolus ephedrine or mephentermine for maintenance of arterial pressure and fetal outcome during spinal anesthesia for the cesarean section

Background and Aims: Spinal anesthesia remains the preferred choice for cesarean deliveries, but hypotension is one of the common complications which may have detrimental effects on both the mother and fetus. In this study, we compared the efficacy and adverse effects of bolus doses of ephedrine hydrochloride and mephentermine sulfate administered intravenously to treat spinal-induced hypotension and the fetal outcomes through Apgar scores and umbilical cord blood gas analysis in the lower segment cesarean section. Material and Methods: In this prospective, randomized, double-blind study, 60 patients undergoing the lower segment cesarean section (LSCS) under spinal anesthesia were randomized into two groups of 30 each using computer-generated random numbers which were kept in an opaque envelope. Patients were pre-loaded with Ringer's lactate solution 10 ml/kg before the spinal anesthesia. Hypotension was defined as the fall in systolic blood pressure of less than or equal to 20% of the baseline or systolic blood pressure of less than 90 mmHg. Whenever hypotension occurred, patients in group E (ephedrine) received a bolus dose of ephedrine 6 mg intravenous and patients in group M (mephentermine) received a bolus dose of mephentermine 6 mg intravenous. Intra-operative recording included maternal hemodynamic parameters and the number of bolus doses of study drugs required to treat maternal hypotension and the adverse effects of study drugs. The Apgar score and umbilical cord blood gas values were recorded. Data were analyzed by analysis of variance test, Student's t-test, and Chi-square test. A P value of < 0.05 was considered as significant. Results: There was a statistically significant (p < 0.05) increase in systolic and mean arterial blood pressure at the second min and fourth min after administration of ephedrine in group E compared to mephentermine in group M. The systolic blood pressure at the second min in the ephedrine group was 114.3 ± 12.06, whereas in the mephentermine group, it was 106.10 ± 8.41 and was statistically significant (p < 0.05). At the fourth min, the systolic blood pressure in the ephedrine group was 115.03 ± 8.87, whereas in the mephentermine group, it was 108.46 ± 8.10 and was statistically significant (p < 0.05). There was a transient increase in heart rate immediately after administration of spinal anesthesia. The mean number of bolus doses of vasopressor consumption was 2.4 (14.4 mg) in the ephedrine group and 2 (12 mg) in the mephentermine group. The umbilical cord blood gas analysis and Apgar scores were similar in both the groups. Three patients (10%) developed bradycardia in the mephentermine group compared to the ephedrine group (0%). The incidence of nausea (13.3% vs 3.3%) and vomiting (10% vs 1%) was higher in the ephedrine group compared to the mephentermne group, and it was not statistically significant (p > 0.05). No significant differences were observed in the umbilical arterial blood pH and Apgar scores. Conclusion: In conclusion, after hypotension, ephedrine and mephentermine administration as bolus doses are equally efficacious in preventing spinal-induced hypotension in patients undergoing the cesarean section and are associated with similar neonatal outcomes.

Mephentermine vs. Phenylephrine for Prevention and Management of Maternal Hypotension during Caesarean Section under Spinal Anaesthesia and their Effects on Foetal Outcome- A Randomised Control Trial

Introduction: For the best maternal and foetal outcome during caesarean section under spinal anaesthesia, maintaining Systolic Blood Pressure (SBP) at 100% of the baseline is necessary. Mephentermine and Phenylephrine are both sympathomimetic drugs used for timely correction of maternal hypotension. Aim: To compare the effect of intravenous bolus administration of mephentermine and phenylephrine for prevention and management of maternal hypotension and to evaluate the foetal outcome. Materials and Methods: In this randomised double-blinded controlled trial, a total of 150 American Society of Anaesthesiologist (ASA) II scheduled for elective Lower Segment Caeserean Section (LSCS) were randomly allocated into three groups to receive the study drugs: group A received mephentermine 6 mg in 2 mL Normal Saline (NS), group B received phenylephrine 100 mcg in 2 mL NS, and group C received 2 mL NS immediately following subarachnoid block. Whenever hypotension occurred (Systolic Blood Pressure (SBP) &lt;90 mm Hg) rescue boluses were given. Maternal haemodynamic parameters, umbilical cord blood gases, and complications were recorded from the time of sub-arachnoid block till the end of surgery. Results: There was no significant difference in the maternal haemodynamics and neonatal outcome among the three groups. It was observed that phenylephrine had quick peak effect, higher foetal umbilical pH and better neonatal outcome though statistically insignificant. Incidence of significant bradycardia (16%) and absence of intraoperative nausea and vomiting were also reported among group B. None of the neonate had APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score &lt;7 and the umbilical pH was comparable in all the three groups (p &gt;0.05). The time of first rescue vasopressor and the total volume of requirement was earlier and higher in group C with the mean timing of 5.87±4.37 min and mean volume of 2.68±1.58 mL respectively. Conclusion: There is a significant improvement of arterial blood pressures and better neonatal outcome observed when phenylephrine (100 mcg) and mephentermine (6 mg) are given as a prophylactic intravenous (i.v.) bolus dose immediately after subarachnoid block; especially in the initial time period between skin incision and delivery of the baby. When given as a prophylactic i.v. bolus, it had the advantage of lesser total dose requirement of the vasopressor used and better haemodynamic maintenance till the delivery of the baby

Importance of maternal ischemia modified albumin, non stress test and doppler ultrasonography in foreseeing perinatal asphyxia

Background: The aim of this study is to evaluate the importance of ischemia changed albumin, in foreseeing fetal asphyxia and comparing it between normal and preeclamptic pregnant. Method: We planned our study as a prospective case-controlled study between May 2011 and June 2013. We recruited 104 pregnant women complicated by preeclampsia and 110 healthy pregnant women in the study. Doppler ultrasonography, non-stress test and fetal biometric measurements were performed. Venous blood samples taken to measure ischemia modified albumin (IMA). The presence of fetal hypoxia/acidosis was analyzed by conducting post-natal cord blood gas examination and 1.-5. minutes APGAR scoring. Results: Women with preeclampsia had higher IMA compared to controls. The correlations between umbilical artery doppler systolic/diastolic (S/D) ratio, brain sparing effect, non stress test and IMA analyzed. We have found IMA statistically high when S/D ratio is above 2 standard deviations (preeclampsia; 11.83±1.33 vs 19.62±1.56 p&lt;0.001, control; 10.28±1.57 vs 18.09±2.13 p&lt;0.001) or brain sparing effect started (preeclampsia; 25.59±2.48 vs 9.16±1.99 p&lt;0.001, control; 16.37±1.97 vs 6.72± 1.53 p&lt;0.001) or abnormal NST findings occurred (preeclampsia; 10.69±1.92 vs 20.72±1.15 p&lt;0.001, control; 7,42±1,94 vs 9,72±2,19 p&lt;0.001). Conclusions: Maternal IMA levels are found high in preeclamptic pregnant women and it can be used as a biomarker for determining fetal wellbeing.

Standardized Evaluation of Cord Gases in Neonates at Risk for Hypoxic Ischemic Encephalopathy.

Umbilical-cord acidemia may indicate perinatal asphyxia and places a neonate at increased risk for hypoxic ischemic encephalopathy (HIE). Our specific aim was to develop a standardized clinical care pathway, ensuring timely identification and evaluation of neonates with umbilical-cord acidemia at risk for HIE. A standardized clinical care pathway to screen inborn neonates ≥36 weeks with abnormal cord blood gases (a pH of ≤7.0 or base deficit of ≥10) for HIE was implemented in January 2016. Abnormal cord blood gases resulted in a direct notification from the laboratory to an on-call physician. Evaluation included a modified Sarnat examination, postnatal blood gas, and standardized documentation. The percentage of neonates in which physician notification, documented Sarnat examination, and postnatal blood gas occurred was examined for 6 months before and 35 months after implementation. Of 203 neonates with abnormal cord gases in the post-quality improvement (QI) period, physician notification occurred in 92%. In the post-QI period, 94% had a documented Sarnat examination, and 94% had postnatal blood gas, compared with 16% and 11%, respectively, of 87 neonates in the pre-QI period. In the post-QI period, of those evaluated, >96% were documented within 4 hours of birth. In the post-QI period, 15 (7.4%) neonates were cooled; 13 were in the NICU at time of identification, but 2 were identified in the newborn nursery and redirected to the NICU for cooling. A standardized screening pathway in neonates with umbilical-cord acidemia led to timely identification and evaluation of neonates at risk for HIE.

A prospective study of analysis of Cord blood gas to predict the short term outcome in high-risk deliveries

Background: Neonatal acidaemia at birth will increase the neonatal morbidity and mortality. It is a predictive marker of neonatal asphyxia. The current study aimed to investigate the relationship between cord blood gas analysis and neonatal outcome.Methods: A prospective hospital based observational study conducted in 150 term newborns. Cord Blood gas levels were examined, pH of 7.25 was observed in 70 samples. The primary outcomes measured were the percentage of NICU admission, need for resuscitation, convulsions, and encephalopathy.Results: Primary outcome of NICU admission, need for resuscitation, and delay in attaining full feeds were observed to have statistical significance. The majority of the babies had pH levels that were within the normal range and had a healthy outcome. NICU admission and the need for resuscitation were observed in babies from group with acidic pH (&lt;7.25).Conclusions: Cord blood analysis had prognostic significance in predicting outcomes in the new-born period.

A Full-term Infant with Seizures.

A Full-term Infant with Seizures.

Calcium and lactate in the fetal-to-neonatal transition

Objective To explore the relationship between calcium and lactate in arterial cord blood of healthy term neonates in response to the stress of labor. Methods This was a prospective cohort study of consecutive, vaginal, term births in a community medical center (April 2029 to February 2020). Calcium and lactate were measured in cord blood gas analysis immediately after delivery. Results In the arterial cord blood of 480 neonates, calcium levels were 1.5 (1.4; 1.5) mmol/L and lactate levels were 3.8 (2.9; 4.9) mmol/L. Calcium and lactate showed a statistically significant positive correlation (Pearson’s correlation, r = 0.15, p = .001). Calcium levels had a significant positive correlation with PaCO2 and a significant negative correlation with pH, PaO2, HCO3 −, and ABE levels. Multivariable analysis models confirmed that calcium levels were associated with HCO3 −, gestational age, and birth weight, all accounting for 7% of the variability. Conclusion In healthy term vaginally delivered neonates, it was found that calcium and lactate were strongly correlated, together pointing to a neonatal response to the stress of labor and delivery. Cord blood calcium regulation may have an ancillary role in defining neonatal adaptation to extrauterine life.

Association of Self-Reported Physical Fitness during Late Pregnancy with Birth Outcomes and Oxytocin Administration during Labour-The GESTAFIT Project.

We explored (a) the associations between self-reported maternal physical fitness and birth outcomes; (b) whether self-reported maternal physical fitness (PF) is related to the administration of oxytocin to induce or stimulate labour. Pregnant women from the GESTAFIT project randomized controlled trial (n = 117) participated in this prospective longitudinal study. Maternal physical fitness was assessed through the International Fitness Scale at the 34th gestational week. Maternal and neonatal birth outcomes and oxytocin administration were collected from the obstetric medical records. Umbilical arterial and venous cord blood gas were analysed immediately after birth. Self-reported overall fitness, cardiorespiratory fitness, muscular strength and flexibility were not related to any maternal and neonatal birth outcomes (all p > 0.05). Greater speed-agility was associated with a more alkaline arterial (p = 0.04) and venous (p = 0.02) pH in the umbilical cord blood. Women who were administered oxytocin to induce or stimulate labour reported lower cardiorespiratory fitness (p = 0.013, Cohen’s d = 0.55; 95% confidence interval (CI): 0.14, 0.93) and flexibility (p = 0.040, Cohen´s d = 0.51; 95% CI: 0.09, 0.89) compared to women who were not administered oxytocin. Greater maternal physical fitness during pregnancy could be associated with better neonatal birth outcomes and lower risk of needing oxytocin administration.

Different antecedents and neonatal condition in neonatal arterial ischemic stroke and hypoxic-ischemic neonatal encephalopathy.

ObjectiveTo define similarities and differences between neonatal arterial ischemic stroke (NAIS) and hypoxic‐ischemic neonatal encephalopathy (HINE).MethodsA retrospective case‐control study was conducted of neonates born at 35 weeks or more and weighing 1800 g or more at a tertiary care university hospital, between 2005 and 2016, with NAIS (group A), perinatal asphyxia (PA) with Stage II–III HINE (group B), and PA with or without Stage I HINE (group C). Ante‐ and intrapartum data, neonatal characteristics, and placental histopathology were compared.ResultsEleven neonates were identified in group A, 10 in group B, and 227 in group C. Sentinel events occurred exclusively in groups B (80%) and C (41.4%). Umbilical cord blood gas values and Apgar score were worse in groups B and C compared to group A. No group A neonates required resuscitation at birth, whereas all group B and one‐third of group C neonates did. Seizures developed only in neonates in groups A and B. One neonatal death occurred in group A. There were no significant differences in placental histopathology.ConclusionNAIS and PA/HINE cases have different intrapartum and neonatal features. PA does not seem necessary for the occurrence of NAIS. More research is needed regarding associated placental abnormalities.

COMPREHENSIVE NEUROMONITORING OF THE NEWBORN WITH MANIFESTATIONS OF SEVERE ASPHYXIA AND THERAPEUTIC HY

Birth asphyxia is a separate nosological form characterized by clinical symptoms ofcardiorespiratory and neurological depression of a newbornwith possible subsequent development of encephalopathyand multiorgan dysfunction, as well as laboratory signsof side effects of fetal hypoxia before or during childbirth(significant metabolic or mixed acidosis in umbilical cordblood gases). The current method of treatment of childrenwith manifestations of asphyxia is therapeutic hypothermia,that should be accompanied by continuous monitoring ofthe patient's cerebral functions.The article presents a clinical case of severe asphyxiain the full-term boy born by cesarean section due to fetaldistress and effusion of meconium amniotic fluid. The scoreon the Apgar scale was 1 point at the end of the first minuteof life, and 3 points five minutes after birth. Therapeutichypothermia by passive cooling was started at the maternityhospital and continued in the intensive care unit of NationalChildren’s Specialized Hospital “OKHMATDYT” of theMinistry of Health of Ukraine (Kyiv, Ukraine).The child was getting dynamic complex neuromonitoringthat included clinical assessment of neurologicalstatus, cerebral oximetry by near-infrared spectroscopy,neurosonography, magnetic resonance imaging, videoelectroencephalographic monitoring and polysomnography.The results of a comprehensive examination of the childmade it possible to identify functional markers of cerebraldisorders: cortical rhythm depression, electro-clinicalseizures, changes in oxygenation of brain tissues, signs ofleukomalacia and ischemic damage, etc. Polysomnographicsigns of sleep-related breathing disorders were found outwith the development of mild apnea-hypopnea syndrome,sinus bradycardia, delayed maturation of physiologicalsleep precursors. Delayed motor development withoutstructural epilepsy were noted at follow-up at the age of2 months.

Umbilical Cord Blood Gas Parameters and Apgar Scoring in Assessment of New-Born Dogs Delivered by Cesarean Section.

Simple SummaryThe article presents the results of the clinical evaluation and umbilical cord blood analysis obtained from newborn pups delivered by the elective Caesarean section. In human medicine both the umbilical cord blood and Apgar score were proved to provide valuable information on neonatal status. In veterinary medicine very few reports concerning the relation between the clinical neonatal assessment (Apgar score) and umbilical cord blood parameters exist. All puppies show mild respiratory acidemia regardless the Apgar scores result. The lactates were not elevated whereas all the puppies with low Apgar sores had higher glucose and mortality rates. Only pups with low initial Apgar scores were at risk of death within first 24 h. Adaptation to the extra-uterine life is crucial and any practical improvement in neonatal diagnostics and care would be beneficial for newborn puppy survival.The article presents the results of the clinical evaluation (Apgar scores, AS) and umbilical cord blood gas analysis (UCBGA) obtained from clamped umbilical cords of newborn pups delivered by the elective Caesarean section. The study was planned as a controlled clinical study, the newborns were allocated into one of the groups, I—critical neonates (severe distress, AS ≤ 3), II—weak neonates (moderate distress, AS 4–6) and III—healthy neonates (no distress, AS ≥ 7). The following parameters were evaluated: pH (pH units), carbon dioxide partial pressure (pCO2; mmHg), oxygen partial pressure (pO2; mmHg), actual bicarbonate (cHCO3−; mmol/L), total carbon dioxide (cTCO2; mmol/L), base excess of extracellular fluid (BE(ecf); mmol/L), base excess of blood (BE(b); mmol/L), oxygen saturation (csO2; %), lactate (Lac; mg/dL), hematocrit (Hct; %PCV), hemoglobin (cHgb; g/dL), glucose (Glu; mg/dL), ions (Na, K, Ca, Cl). The majority of puppies had low AS at birth (AS 4–6 in 38.1% and AS ≤ 3 in 57.1% of the neonates), but most of them (85.7%) improved by the 20th min. reaching AS of 7 and more. Moreover, puppies with lower AS (≤ 3) were at higher risk of death within the first 24h (20.8% did not survive). The positive correlation was found between Apgar score measured at 0 min and pH (r = 0.46, p = 0.01), and between Apgar score (at 0 min) and base excess in whole blood measured [BE(b)] r = 0.36, p = 0.03). Whereas, a negative correlation was detected between Apgar score at 0 and 5th min and glycemia (r = −0.42, p = 0.05, r = −0.34, p = 0.02 respectively. Overall, the puppies with higher glucose levels had lower Apgar scores and were at higher risk of death. Furthermore, in our study, the newborn puppies had mild acidemia with elevated pCO2 levels and the HCO3 at the lower range of normal limits, suggesting the mixed component in the acidemic state. Adaptation to extra-uterine life is crucial and any practical improvement in neonatal diagnostics and care would be beneficial for newborn puppy survival.

Correlation of electroencephalogram background evolution with the degree of brain injury in neonates with hypoxic-ischemic encephalopathy.

To study the correlation of electroencephalogram (EEG) background evolution with the degree of brain injury in neonates with hypoxic-ischemic encephalopathy (HIE). A retrospective analysis was performed for 56 neonates with HIE who underwent continuous video electroencephalogram (cVEEG) and brain magnetic resonance imaging (MRI) examinations. According to clinical symptoms, they were divided into a mild group with 3 neonates, a moderate group with 36 neonates, and a severe group with 17 neonates. EEG background grading and MRI score were determined for each group to analyze the correlation of EEG background evolution with the degree of brain injury. Compared with the moderate group, the severe group had significantly lower gestational age and Apgar score at 5 minutes after birth, a significantly higher resuscitation score, significantly lower base excess in umbilical cord blood or blood gas within 1 hour, a significantly higher proportion of neonates on mechanical ventilation, and a significantly higher incidence rate of short-term adverse outcomes (P<0.05). For the neonates in the mild and moderate groups, MRI mainly showed no brain injury (67%, 2/3) and watershed injury (67%, 16/24) respectively, and EEG showed mild abnormality in 62% (13/21) of the neonates on the 3rd day after birth. For the neonates in the severe group, MRI mainly showed basal ganglia/thalamus + brainstem injury (24%, 4/17) and whole brain injury (71%, 12/17), and EEG showed moderate or severe abnormalities on the 3rd day after birth. EEG background grading was correlated with clinical grading, MRI score, and short-term outcome on days 1, 2, 3 and 7-14 after birth (P<0.01). The highest correlation coefficient between EEG grading and MRI score was observed on the 3rd day after birth (rs=0.751, P<0.001), and the highest correlation coefficients between EEG grading and clinical grading (rs=0.592, P=0.002) and between EEG grading and short-term outcome (rs=0.737, P<0.001) were observed 7-14 days after birth. Among the neonates with severe abnormal EEG, the neonates without brain electrical activity had the highest MRI score, followed by those with status epileptics and persistent low voltage (P<0.05). There is a good correlation between EEG background grading and degree of brain injury in neonates with HIE, which can help to evaluate the degree and prognosis of brain injury in the early stage.

500 Obesity is associated with increased rates of umbilical artery pH< 7.1 at scheduled cesarean delivery

Limited data suggest obese women are at increased risk for decreased fetal umbilical artery (UA) pH prior to the onset of labor. Reduction in venous return from the weight of the abdominal wall and a decrease in maternal blood pressure in response to neuraxial anesthesia may contribute to hypoperfusion leading to a decreased UA pH. We hypothesize that obese women are at increased risk for UA pH <7.1 at time of non-labor cesarean delivery (CD) under neuraxial anesthesia. This multi-center retrospective cohort includes women who delivered a term, singleton, non-anomalous neonate from 2013-2019 via non-labor CD under neuraxial anesthesia. Multiple gestations and patients with suspected fetal growth restriction were excluded. Universal cord gas collection was routinely performed. Primary outcome was fetal UA pH <7.1 and base deficit ≥12 mmol in obese vs. non-obese gravidas. Secondary outcomes included NICU admission and other neonatal morbidities. Outcomes were assessed using multivariable logistic or linear regression and adjusted for age, race/ethnicity, insurance type, number of prior CDs, maternal medical problems, time from anesthesia placement to delivery and time from skin incision to delivery. Obesity was associated with younger maternal age, longer time from anesthesia placement and skin incision to delivery, non-White race, public insurance, higher order CD, tobacco use, hypertensive disorders and diabetes (all p<0.01). Obese patients were significantly more likely to have UA pH <7.1 (aOR 2.4, 95% CI 1.5-3.6; p<0.01) and UA base deficit ≥12 mmol (aOR 3.1, 95% CI 1.5-3.6; p<0.01). There was a significant trend toward UA pH <7.1 and base deficit ≥12 mmol with increasing class of obesity. We found no differences in secondary outcomes between groups. Maternal obesity is associated with increased rates of UA pH <7.1 and base deficit ≥12 mmol at time of non-labor CD under neuraxial anesthesia. These findings may prompt alterations in management of the obese parturient and may alter prediction of adverse outcomes in the neonate by fetal cord blood gas results.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Cord blood gas results of pregnancies complicated by preeclampsia and the relationship of these results with the amount of proteinuria.

To evaluate whether there is a statistically significant difference between the cord blood gas parameters of pregnancies complicated with preeclampsia and uncomplicated pregnancies and to show whether the amount of proteinuria affects fetal cord blood gas parameters in pregnancies complicated with preeclampsia. The study was designed retrospectively. Between 2016 and 2019, the neonatal results and cord blood gas results of 109 pregnant women who were diagnosed with preeclampsia and 75 nonpreeclamptic randomly selected pregnant women were compared. The preeclampsia group was divided into groups according to amount of proteinuria. SPSS 21.0 statistics program was used, and comparative analysis was carried out. The data of the 109 preeclampsia cases and 75 control groups included in the study were compared, and there was no statistical difference between the fetal cord blood gas parameters between the groups (p > 0.05). The median first and fifth minute Apgar scores were found significantly lower in the preeclampsia group compared to the control group (6, 8 and 8, 9, respectively; p < 0.001). Also, the amount of proteinuria does not alter cord blood gas parameters (p > 0.05). Preeclampsia poses a risk for the neonatal period as it reduces the neonatal Apgar scores due to the chronic hypoxic process it creates. However, it was observed that the amount of proteinuria, which is one of the diagnostic criteria, did not affect neonatal results on Apgar scores or fetal cord blood gas parameters.

Mid forceps did not cause “compromised babies” – “compromise” caused forceps: an approach toward safely lowering the cesarean delivery rate*

Objective Over 5 decades, Cesarean Delivery rates (CDR) have risen 6-fold while vaginal operative deliveries [VODs] decreased from >20% to ∼3%. Poor outcomes (HIE and cerebral palsy) haven’t improved. Potentiating the virtual abandonment of forceps (F), particularly midforceps (Mid), were allegations about various poor neonatal outcomes. Here, we evaluate VOD and CDR outcomes controlling for prior fetal risk metrics (PR) ascertained an hour before birth. Methods Our 45-year-old database from a labor research unit of moderate/high risk laboring patients (288 NSVDs, 120 Lows, 30 Mids, and 32 CDs) had multiple fetal scalp samples for base excess (BE), pH, cord blood gases (CB), and umbilical artery bloods. ANOVA established relationships between birth methods and outcomes (Cord blood BE and pH and 1 and 5 min Apgar scores); correlations, and two-step multiple regression assessed PR for delivery method and neonatal outcomes. The main outcome measures were correlations of outcome measures with fetal scalp sample BE and pH up to an hour before delivery and fetal reserve index scores scored concurrently. Results NSVDs had the best immediate neonatal outcomes with significantly higher CB pH and BE as compared to forceps and CDs. However, controlling for PR revealed: (1) PR at 1 h before delivery correlated with delivery mode, i.e. the decrements in outcomes were already present before the delivery was performed; and (2) The presumed deleterious effects of interventional deliveries, per se, were significantly reduced, and (3) Fetal Reserve Index predicted neonatal outcomes better than fetal scalp sample BE, pH, or delivery mode. Conclusion The historical belief that MF deliveries caused poorer outcomes than NSVDs seems mostly backwards. Appreciating PR’s impact on delivery routes, and when appropriate, properly performing VODs could safely reduce CDR. If our approach lowered CDR by only ∼2%, in the United States about 80,000 CDs might be avoided, saving ∼$750 Million yearly. In the post pandemic world, safely apportioning medical expenses will be even more critical than previously.