Umbilical Arterial Blood Gas Values Research Articles

Comparison of crystalloid and colloid co-load combined with norepinephrine prophylaxis on post-spinal anesthesia hypotension during cesarean delivery: a randomized sequential allocation dose-finding study.

Fluid loading is an essential component of treatment for reducing the incidence of post-spinal anesthesia hypotension and is necessary to maintain intravascular volume, perfuse tissues, and control spinal anesthesia hypotension after sympathetic blockade. We performed a randomized sequential allocation dose-finding study to compare the effects of 10 mL/kg crystalloid and 6% hydroxyethyl starch (130/0.4) co-load on the ED90 of prophylactic norepinephrine infusion for preventing post-spinal anesthesia hypotension during cesarean delivery. Eighty patients were randomly allocated to receive either a 10 mL/kg crystalloid (Crystalloid Group, n = 40) or 6% hydroxyethyl starch (130/0.4) (Colloid Group, n = 40) co-load combined with prophylactic norepinephrine infusion during spinal anesthesia for cesarean delivery. The first patient received an initial prophylactic norepinephrine infusion rate of 0.025 μg/kg/min. Subsequent patients received a 0.005 μg/kg/min gradient dose of prophylactic norepinephrine. This dose was administered as a gradient based on its effectiveness for preventing post-spinal anesthesia hypotension (defined as SBP < 80% of baseline value) and determined by the up-and-down sequential allocation methodology. The primary study outcome was the ED90 of prophylactic norepinephrine infusion. Secondary outcomes included the incidence of post-spinal anesthesia hypotension, bradycardia, hypertension, Apgar scores, and umbilical artery blood gas values were also measured. The ED90 values of prophylactic norepinephrine infusion for preventing post-spinal anesthesia hypotension during cesarean delivery were 0.063 μg (95% CI: 0.050 to 0.064) and 0.062 μg (95% CI: 0.045 to 0.064) using isotonic regression analysis, and 0.068 μg (95% CI: 0.056 to 0.353) and 0.060 μg (95% CI: 0.050 to 3.590) using probit regression analysis in the Crystalloid Group and Colloid Group, respectively. The secondary outcomes were comparable between the two groups. The administration of a 10 mL/kg 6% hydroxyethyl starch (130/0.4) does not provide additional benefits compared to crystalloid co-load in reducing the ED90 of prophylactic norepinephrine infusion for preventing post-spinal anesthesia hypotension during cesarean delivery.

COMPARISON OF THE EFFECT OF PHENYLEPHRINE AND EPHEDRINE ON UMBILICALARTERIAL BLOOD GAS PARAMETERS IN ELECTIVE CAESAREAN SECTION UNDER LUMBAR SUBARACHNOID BLOCK

Introduction: Potential side effects such as supraventricular tachycardia, tachyphylaxis, and most importantly, fetal acidosis render the use of ephedrine as a rst line agent to treat hypotension in obstetric patient debatable. Phenylephrine, an alternative drug, has a reduced incidence of nausea and vomiting as well as decreased fetal acidosis, which gives it an advantage over the use of ephedrine. Materials and methods: We conducted an observational study in 68 ASA II patients scheduled for lower segment caesarean section. Parturients who satised the inclusion criteria were randomly assigned into one of the two groups of 34 each- group P with parturients who were to receive phenylephrine boluses in 100 mcg increments and group E with parturients who were to receive ephedrine boluses in 6mg increments when they developed hypotension. Fetal umbilical arterial blood gas was analyzed and parameters were compared. Results: On analyzing umbilical arterial blood values, a lower mean pH was found in group E (7.27± 0.09) when compared to group P (7.3± 0.04). Also a higher PCO value (49± 7.4) was found in group E when compared to group P (43.9 ± 6.4). Other umbilical arterial blood gas values were 2 comparable between both groups

Comparison: The Effect of Ephedrine and Phenylephrine in Treatment of Hypotension after Spinal Anesthesia during Cesarean Section

Background and Objective: The effectiveness of ephedrine and/or phenylephrine, in treatment of hypotension secondary to spinal anesthesia for cesarean section and their effects on fetal/neonatal outcome were studied. Methods and Materials: Sixty healthy parturients were randomly assigned to two groups; Group A (n = 30) received boluses 5 mg/ml increments Ephedrine and, Group B (n = 30) received a boluses of phenylephrine 20 µg/ml increments for treatment of hypotension after spinal block during cesarean section. Changes in maternal blood pressure and heart rate, and incidence of nausea-vomiting, neonatal Apgar score at 1 and 5 minutes of delivery, and umbilical arterial blood gas values were recorded. Results: There were no differences in treatment of hypotension following sympathectomy after spinal block with two drugs. Neonatal outcome was similar in two groups. There were not significant differences in umbilical arterial values in two groups. Conclusion: Ephedrine and phenylephrine are both effective vasopressors for treatment of hypotension associated to spinal block during cesarean section without adverse effects on infants/neonates.

The effects of a history of seizures during pregnancy on umbilical arterial blood gas values in pregnant women with epilepsy.

The objective of this study is to investigate if the number of seizures that occur during pregnancy has any effect on umbilical arterial blood gas values at delivery. In total, 55 women who were 37 to 41 weeks pregnant and diagnosed with generalized tonic-clonic epilepsy and 50 pregnant women with similar characteristics but not diagnosed as epileptic were included in this study. The patients diagnosed with epilepsy were divided into two groups: 27 patients with a history of at least 5 epileptic seizures during pregnancy and 28 who had no seizures during pregnancy. All patients diagnosed with epilepsy had a history of caesarean delivery or a caesarean section under general anesthesia on the advice of neurology. Pregnant women in the control group were also chosen from among patients who had a caesarean on account of a previous caesarean delivery. In the cases included in the study, umbilical arterial blood gas sampling was performed immediately after delivery. When the control group without epilepsy was compared with pregnant women who had no history of epileptic seizures during pregnancy, no difference was found in umbilical arterial blood gas values (p>0.05). When patients with a history of 5 or more epileptic seizures during pregnancy were compared with the control group without epilepsy and the patients with epilepsy who had no history of seizures during pregnancy, there was no statistically significant difference (p>0.05), although their umbilical arterial blood pH values were found to be lower, while partial carbon dioxide pressure (pCO2), values were higher and partial oxygen pressure (pO2) values were lower. Taking potential fetal risks into consideration, maternal generalized tonic-clonic epileptic seizures might be worrying. Tonic-clonic seizures that occur during pregnancy appear to be associated with temporary hypoxia. Therefore, monotherapy for seizures and treatment at the lowest effective dose should be administered to women with epilepsy in the preconception and prenatal term.

Comparison the effect of ephedrine and phenylephrine in treatment of hypotension after spinal anesthesia during cesarean section

Background and Objective: The effectiveness of ephedrine and/or phenylephrine, in treatment of hypotension secondary to spinal anesthesia for cesarean section and their effects on fetal/neonatal outcome were studied. Methods and Materials: Sixty healthy parturients were randomly assigned to two groups; group E (n = 33) received boluses 5 mg/ml increments ephedrine and group P (n = 27) received a boluses of phnylephrine 100 μg/ml increments for treatment of hypotension after spinal block during cesarean section. Changes in maternal blood pressure and heart rate, and incidence of nausea-vomiting, neonatal Apgar score at 1 and 5 minutes of delivery, and umbilical arterial blood gas values were recorded. Results: There were no differences in treatment of hypotension following sympathectomy after spinal block with two drugs. Neonatal outcome was similar in two groups. There were not significant differences in umbilical arterial values in two groups. Conclusion: Ephedrine and phenylephrine are both effective vasopressores for treatment of hypotension associated to spinal block during cesarean section without adverse effects on infants/neonates.

Comparison of the umbilical artery blood gas, nucleated red blood cell, C-reactive protein, and white blood cell differential counts between neonates of diabetic and nondiabetic mothers

Objective The aim of this study was to compare the neonatal umbilical artery blood gas values, C-reactive protein (CRP) levels, nucleated red blood cells (NRBCs), and white blood cells (WBCs) differential counts between offspring’s of the diabetic mothers who needed insulin during pregnancy and normal mothers after cesarean delivery. Materials and Methods A prospective study was performed involving 68 pregnant diabetic women who needed insulin during pregnancy and 410 healthy pregnant women and their neonates with gestational ages between 35 weeks and 41 weeks. Arterial blood was analyzed for pH and blood gas values and venous blood was analyzed for CRP level, NRBC, and WBC differential counts. Results The mean NRBC count in the neonates of diabetic mothers and healthy mothers was 560 ± 985/μL and 202 ± 281/μL, respectively ( p < 0.001). The umbilical arterial blood gas showed a lower pH (7.22 ± 0.07 vs. 7.24 ± 0.04, p = 0.004) and a higher pCO 2 (49.33 ± 10.08 vs. 47 ± 8.67, p = 0.045) in neonates of diabetic mothers compared with the controls. Values of pO 2, HCO 3 −, base excess, WBC differential counts, and CRP levels were almost similar in the two groups. Conclusion Lower pH, higher pCO 2, and elevated NRBC counts were found in the neonates of diabetic mothers that may be suggestive of chronic intrauterine acidosis.

Umbilical Arterial Blood Gas and Perinatal Outcome in the Second Twin according to the Planned Mode of Delivery

To compare umbilical arterial gas parameters in the second twin of twin pregnancies according to the mode of delivery. We retrospectively analyzed the medical records of twin deliveries after 34 weeks of gestation for 3 years. Excluding the cases which underwent emergency cesarean delivery during trial of labor, a total of 79 twin gestations had umbilical arterial blood gas values available and were and divided into cesarean delivery group (N=40) and vaginal delivery group (N=39). The mean differences of umbilical arterial blood parameters and the Apgar score between the first and second twin in each pregnancy were compared according the mode of delivery. The differences of umbilical arterial gas parameters between twin siblings showed no significant difference according to the mode of delivery. With regard to the 1 minute and 5 minute Apgar scores, the differences between twin siblings are significantly increased in vaginal delivery group compared to cesarean delivery group (p=0.048, and p=0.038, respectively). In comparing the 28 cases delivered vaginally with an inter-twin delivery interval < 10 minutes and 40 cases delivered by cesarean section, no significant differences were observed in the umbilical arterial gas parameters and Apgar scores. The inter-twin umbilical arterial blood gas parameters according to the mode of delivery showed no difference. For twin deliveries, it is relatively safe to plan for a vaginal delivery, but an effort should be made to reduce the inter-twin delivery interval time.

Periodontal treatment did not prevent complications of pregnancy

A randomised controlled trial (RCT) was conducted. Women found to have a periodontal disease were randomly allocated to receive periodontal treatment in midpregnancy (this was the treatment group; n = 542) or after the pregnancy was concluded (the control group; n = 540). Periodontal disease was defined as presence of periodontal pockets of 4 mm or greater in depth at 12 or more probing sites in fully erupted teeth (typically excluding wisdom teeth). Treatments were conducted either by the hygienists or periodontists and included nonsurgical debridement of the subgingival and supragingival plaque, removal of local predisposing factors such as calculus, root planing, and adjustment of overhanging restorations. Comprehensive oral hygiene instructions and motivation were provided at each visit at a minimum of three weekly visits, with further visits if required. The primary outcomes were preterm birth or other major complications of pregnancy. There were no differences between the control and treatment groups in terms of: preterm birth [9.3% compared with 9.7%; odds ratio (OR), 1.05; 95% confidence interval (CI), 0.7-1.58; P 0.81); birthweight (3450 g versus 3410 g; P 0.12); pre-eclampsia (4.1% versus 3.4%; OR, 0.82; 95% CI, 0.44-1.56; P 0.55); or other obstetric endpoints. There were four unexplained stillbirths in the control group and no pregnancy losses in the treated group (P 0.12). Measures of foetal and neonatal wellbeing were similar in the two groups, including abnormalities in foetal heart rate recordings (P 0.26), umbilical artery flow studies (P 0.96), and umbilical artery blood gas values (P 0.37). The periodontal treatment was highly successful in improving health of the gums (P<0.01). The evidence provided by the present study does not support the hypothesis that treatment of periodontal disease during pregnancy in this population prevents preterm birth, foetal growth restriction, or pre-eclampsia. Periodontal treatment was not hazardous to the women or their pregnancies.

Treatment of Periodontal Disease During Pregnancy

To investigate whether treating periodontal disease prevents preterm birth and other major complications of pregnancy. This single-center trial was conducted across six obstetric sites in metropolitan Perth, Western Australia. Pregnant women identified by history to be at risk (n=3,737) were examined for periodontal disease. Approximately 1,000 women with periodontal disease were allocated at random to receive periodontal treatment commencing around 20 weeks of gestation (n=542) or 6 weeks after the pregnancy was completed (controls; n=540). The treatment included mechanical removal of oral biofilms together with oral hygiene instruction and motivation at a minimum of three weekly visits, with further visits if required. There were no differences between the control and treatment groups in preterm birth (9.3% compared with 9.7%, odds ratio [OR] 1.05, 95% confidence interval [CI 0.7-1.58], P=.81), birth weight (3,450 compared with 3,410 g, P=.12), preeclampsia (4.1% compared with 3.4%, OR 0.82, 95% CI 0.44-1.56, P=.55), or other obstetric endpoints. There were four unexplained stillbirths in the control group and no pregnancy losses in the treated group (P=.12). Measures of fetal and neonatal well-being were similar in the two groups, including abnormalities in fetal heart rate recordings (P=.26), umbilical artery flow studies (P=.96), and umbilical artery blood gas values (P=.37). The periodontal treatment was highly successful in improving health of the gums (P<.01). The evidence provided by the present study does not support the hypothesis that treatment of periodontal disease during pregnancy in this population prevents preterm birth, fetal growth restriction, or preeclampsia. Periodontal treatment was not hazardous to the women or their pregnancies. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00133926. I.

778: Umbilical artery blood gas values in very preterm births and the risk of short-term morbidity

778: Umbilical artery blood gas values in very preterm births and the risk of short-term morbidity

Obstetric Outcome Following Laparoscopic Adjustable Gastric Banding

Ducarme, G.; Revaux, A.; Rodrigues, A.; Aissaoui, F.; Pharisien, I.; Uzan, M. Author Information

Obstetric Outcome Following Laparoscopic Adjustable Gastric Banding

The bariatric procedure laparoscopic adjustable gastric banding (LAGB) was introduced in the 1980s. Since then, it has been used in young obese women who wish to become pregnant and also to lower their risk of complications, even though there is not much data on its effects on maternal and fetal morbidity. This retrospective case-control study enrolled 427 obese women whose prepregnancy body mass index (BMI) was 30 or greater. Thirteen of these women underwent LABG. The interval from LAGB to conception averaged 17 months, and these women lost a mean of 24 kg body weight before becoming pregnant. Mean body weight and BMI at the outset of pregnancy were 95 kg and 34.8, respectively. The LAGB and control groups did not differ with regard to maternal age at the time of conception. Women in the LAGB group gained significantly less weight during pregnancy than did control women (5.5 vs. 7.1 kg). Incidence rates of preeclampsia, gestational diabetes, low birth weight, and fetal macrosomia all were less for women having LAGB than for obese control women. There were, however, no significant differences in rates of induced labor for obstetrical complications or the use of epidural anesthesia. Overall, cesarean deliveries were significantly more frequent in control women than in study cases (34.4% vs. 15.3%). However, this difference was largely due to an increased number of prelabor cesareans in the control group; the rate of cesareans during labor was not different between the groups. The investigators believe that the increased number of prelabor cesareans in the control women was due to higher rates of preeclampsia, gestational diabetes, and low birth weight in this group. Among women having a previous cesarean delivery, the chance of requiring a repeat cesarean was significantly less in the study group. There was no significant group difference in mean birth weight, but low birth weight and macrosomia both were significantly more frequent in control women. Preterm births, 5-minute Apgar scores, and umbilical arterial blood gas values were comparable in the study and control groups. It appears that LAGB lowers the risk of adverse obstetrical complications in obese women. It is a safe procedure and is well tolerated by pregnant women.

Outcomes of Term Vaginal Breech Delivery

In December 2001, the American College of Obstetricians and Gynecologists revised their recommendations for breech delivery. These recommendations acknowledge that although a planned vaginal delivery may no longer be appropriate, there are instances in which vaginal breech delivery is inevitable. Moreover, there continues to be patients who for any number of reasons will choose vaginal over cesarean delivery when faced with a fetus in the breech presentation. We sought to review maternal and fetal outcomes in such circumstances when vaginal breech delivery occurs, and compare these outcomes to elective cesarean deliveries for breech presentation. We performed a retrospective review of all singleton breech deliveries at our county hospital from January 2002 through June 2003. We reviewed maternal age, ethnicity, gestational age, gravity, parity, birthweight, mode of delivery, Apgar scores, umbilical arterial blood gases, and maternal and infant complications of both cesarean deliveries and vaginal breech deliveries. Univariate and logistic regression statistical analyses were performed with NCSS software. We had a total of 150 term breech deliveries with gestational ages between 37 and 42 weeks. Of these, 41 were vaginal breech and 109 were cesarean deliveries. Greater than 95% of patients are of Hispanic origin. There were no statistically significant differences in maternal age, ethnicity, gravity, or gestational age. Mean birthweight was significantly lower and parity was significantly higher in the vaginal delivery group. There was also a higher proportion of patients who underwent labor induction/augmentation in the vaginal group. We found no differences in the outcomes of 5-minute Apgar scores, umbilical arterial blood gas values, neonatal intensive care unit admissions, deaths or maternal/fetal complications reported between the two groups. Mean umbilical arterial blood gas values were greater than 7.18 in both groups. Vaginal breech delivery cannot always be avoided. Moreover, at our county hospital several patients continue to choose vaginal breech delivery. Our data would suggest that vaginal breech delivery remains a viable option in selected patients.

Comparison of 25 and 50 μg Vaginally Administered Misoprostol for Preinduction of Cervical Ripening and Labor Induction

Our purpose was to compare the efficacy of 25 µg and 50 µg intravaginally administered misoprostol tablets for cervical ripening and labor induction. Either 25-µg (n: 58) or 50-µg (n: 56) misoprostol tablets were randomly administered intravaginally to 114 subjects with an unripe cervix for labor induction. The physician was blinded to the medication. Intravaginal misoprostol was given every 4 h until the onset of labor. The mean Bishop score before misoprostol administration was 2.1 ± 1.6 in the 25-µg group and 2.0 ± 1.4 in the 50-µg group (p > 0.05). With the 25-µg dose the time until delivery was significantly longer (991.2 ± 514.4 min vs. 703.12 ± 432.6 min in the 50-µg group). The use of oxytocin augmentation was significantly higher in the 25-µg group (63.8%) than the 50-µg group (32.1%; p < 0.05). The proportions of patients with tachysystoles and hypersystoles were not significantly different between the two groups (19 and 6.9%, respectively, in the 25-µg group and 25 and 17.8%, respectively, in 50-µg group; p > 0.05). Overall, in the 25-µg group more women achieved vaginal delivery (79.3 vs. 60.7%; p < 0.05). The rate of cesarean sections due to nonreassuring fetal status was higher in the 50-µg misoprostol group (28.6 vs. 10.3%; p < 0.05). The number of neonates with a low 1-min Apgar score (<7) was significantly higher in the 50-µg misoprostol group (26.8 vs. 8.6%; p < 0.05), but 5-min Apgar scores and umbilical artery blood gas values at the time of delivery were not significantly different between the groups (p > 0.05). One patient in the 25-µg group suffered a ruptured uterus. Intravaginal administration of 25 µg of misoprostol is a clinically effective labor induction regimen and has the least adverse effects and complications.

Fetal Doppler Hemodynamic Changes in Spontaneous Versus Prostaglandin E1-Induced Active Labor

Background. To assess fetal hemodynamic changes before and during active labor, either spontaneous or prostaglandin E 1 (PGE 1 )-induced labor. Materials and methods. This is a prospective longitudinal study and a cohort of 49 healthy women at 37-41 + weeks gestation without signs of fetal distress was investigated until in labor. One group of 23 healthy women had spontaneous active labor, the second group of 26 women was in active labor induced by an intra-cervical administration of PGE 1 for elective induction. Blood flow waveform indices (S/D ratio, RI, PI) were assessed by pulsed Doppler ultrasonography from the umbilical artery (UA) and fetal middle cerebral artery (MCA) before and in labor. Both groups were compared for the waveform indices and perinatal outcome including duration of labor, meconium stain, baby sex, birthweight, UA blood gas measurements at delivery, Apgar's scores, prolonged nursery stay (≥5 days), and NICU admission. Results. Demographic data of the two groups were comparable. During spontaneous active labor, the S/D ratio and RI became significantly decreased in the UA (p<0.05) and the three waveform indices were decreased more in the MCA (p<0.01, 0.005, 0.05, respectively) compared with those measured before labor. During PGE 1 -induced active labor, all the waveform indices were not significantly decreased in either the UA or the MCA. The occurrence of abnormal UA blood gas values was significantly more in the PGE 1 -induced group than in the spontaneous labor group (23.1% v.s. 4.3%; p<0.05). No other adverse perinatal outcomes were observed in either group. Conclusions. Decreasing impedance in both the UA and MCA during spontaneous labor is a physiological fetal adaptation to labor to prevent fetal cerebral hypoxia by maintaining adequate brain blood flow during normal parturition. This fetal adaptation phenomenon was not observed in the group of PGE 1 -induced labor with the result of a high incidence of abnormal UA blood gas values.

The etiology of fetal acidosis as determined by umbilical cord acid-base studies

OBJECTIVE: Our purpose was to determine whether umbilical cord acid-base values might be used to differentiate abruptio placentae from cord prolapse. STUDY DESIGN: By use of a retrospective study design, umbilical cord blood acid-base values of 32 cases of severely acidotic acute abruptio placentae were statistically compared with those of 19 cases of severely acidotic acute cord prolapse with Fisher's exact test, Mann-Whitney U tests, and receiver-operator curve characteristic analyses. RESULTS: No significant differences in electronic fetal heart rate record interpretations were detected. Highly significant differences in umbilical arterial and umbilical venous blood gas values were noted between the two groups. Most notable were the differences between umbilical venous and arterial blood gas values in the cord prolapse group. Receiver-operator characteristic curve analysis demonstrated that an umbilical venous-arterial pH difference of 0.15 was an effective cutoff value in differentiating cord prolapse from abruptio placentae (accuracy 92%). CONCLUSION: Umbilical arterial blood gas values combined with umbilical venous blood gas values can assist in determining the pathogenesis of marked fetal acidosis. (Am J Obstet Gynecol 1997;177:274-82.)

Antenatal fetal heart-rate variability in relation to fetal acid-base status at caesarean section.

A quantitative comparison was made of fetal heart-rate (FHR) traces obtained shortly before delivery, and of umbilical artery blood gas values, in 49 women delivered by caesarean section for reasons other than fetal compromise and in 23 women delivered by section for antenatal fetal compromise judged from visual inspection of conventional FHR recordings. The FHR traces in the compromised group of fetuses were abnormal, with low variability and a high incidence of decelerations, but there was no significant difference from the normal group in metabolic acidaemia, as judged by the base excess of umbilical artery blood. The compromised group consisted almost exclusively of infants small-for-gestational age. These results suggest that the FHR pattern of the compromised fetuses is not the direct result of intrauterine asphyxia but of some other factor associated with growth retardation.

Changes in Umbilical Artery Blood Gas Values with the Onset of Respiration

Changes in Umbilical Artery Blood Gas Values with the Onset of Respiration