Umbilical Arterial Values Research Articles

Does Metabolic Acidosis Improve or Worsen After Delivery in Critically Ill Neonates?

Umbilical artery (UA) cord blood gasses may be used to assess timeliness of delivery and need for neonatal cooling. If a UA is not obtained, an umbilical artery catheter (UAC) newborn arterial (NA) blood gas may be used to infer UA values, although the relationship between UA and NA values has not been studied. Our aim was to determine the frequency with which metabolic acidosis improves versus worsens and explore factors associated with these changes.

The clinical prognostic significance of myocardial performance index (MPI) in stable placental-mediated disease

To determine whether a single elevated myocardial performance index (MPI) value in the third trimester of pregnancy is a marker for later adverse obstetric outcomes in stable placental-mediated disease, defined as well-controlled pre-eclampsia (PE) on a single agent and/or uncompensated intra-uterine growth restriction (IUGR). Fifty-five foetuses whose mothers had stable placental-mediated disease, either mild pre-eclampsia controlled on a single agent, and/or uncompensated IUGR in the third trimester, attending the Foetal Unit at Inkosi Albert Luthuli Hospital, Durban, South Africa were prospectively recruited with 55 matched controls. Recorded data for the subjects included demographic data of maternal age and parity, sonographic data of estimated foetal weight (EFW) and amniotic fluid index (AFI), myocardial performance index (MPI), and foetal Doppler data of the umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV). The mean gestational age in the controls, the IUGR and any PE cases was 31.4, 31.8 and 31.0 weeks, respectively. The distribution of MPI values was significantly lower in the controls compared to all other groups. The highest standardised MPI values were observed in the PE-IUGR group, where a median of 5.62 was observed. The only significant differences observed between the PE and IUGR groups was the UA resistance index (p = 0.01), where the IUGR cases tended to have higher UA values compared to the combined PE group. Borderline statistical significance was observed for the MCA resistance index values ( p = 0.05) between these groups. The overall adverse event rate in the cases was 49%. The highest rate was observed in the PE + IUGR group, where eight out of 12 (67%) experienced adverse events. MPI z-scores served as a good marker of adverse events, as evidenced by the total area under the curve (AUC) of 0.90 on the ROC curve. A cut-off value of 4.5 on the MPI z-score conferred a sensitivity of 89% and specificity of 68% for an adverse event later in pregnancy. In univariate logistic regression, MPI z-score, AFI, EFW, UA Doppler, CPR category, DV Doppler and MCA Doppler were assessed separately as potential predictors of adverse outcome. The only significant predictor of adverse outcome was MPI z-score. A single elevated value of the MPI ( z-score > 4.5) in the third trimester in stable placental-mediated disease was a strong indicator of adverse obstetric outcomes later in pregnancy. This has the potential to be incorporated in conjunction with standard monitoring models in stable placental-mediated disease to predict an adverse event later in pregnancy and thus to reduce perinatal morbidity and mortality.

Effect of remifentanil for general anesthesia on parturients and newborns undergoing cesarean section: a meta-analysis.

The results presented by studies investigating the effect of remifentanil on both parturients and newborns during cesarean section differed significantly. Therefore, we performed a meta-analysis to estimate the effect of remifentanil on these patients. Potentially eligible studies published before 15 March 2016 were searched through four databases including PubMed, SCOPUS, ISI web of knowledge and EBSCO. Weighted mean difference (WMD) or odds ratios (ORs) and the corresponding 95% confidence interval (CI) were applied to estimate the strength of relationship. A total number of seven randomized-controlled trials were included in this meta-analysis. The results showed that Apgar values at 1 min and 5 min were significantly lower in the infants of remifentanil-treated mothers, with the WMD and corresponding 95% CI of -0.835 (-1.515, -0.154) and -0.296 (-0.570, -0.021), respectively. The pH value of umbilical artery was significantly higher in the remifentanil group (WMD: 0.014, 95% CI: 0.002, 0.025). The highest and lowest systolic blood pressures were significantly lower in remifentanil-treated mothers, with the WMD and corresponding 95% CI of -18.913 (-34.468, -3.359) and -12.982 (-21.479, -4.485), respectively. Remifentanil shows potential value of maternal circulation response during general anesthesia, which reduces maternal blood pressure in response to intubation and surgery. However, whether it is beneficial for the neonate is still controversial. More randomized-controlled trials with larger sample size are required to assess the adverse effects of remifentanil.

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.

Ephedrine and dopamine's hypotension-preventative effect for CSEA in cesarean delivery-A single-blind controlled study

Objective To compare the effects of ephedrine and dopamine in the prevention of hypotension during combined spinal and epidural anesthesia(CSEA)for cesarean delivery. Methods Fifty ASAⅠorⅡpatients undergoing elective cesarean delivery were randomly divided into the two groups, Ephedrine group(n =51): intravenous injection of 10mg ephedrine before anesthesia; Dopamine group(n=52): continuous intravenous infusion at the speed of 5μg·kg-1·min-1.During the whole process, we investigated the incidence rate of adverse effects, compared the Apgar score of neonate and analyzed blood gas of umbilical artery and vein. Results Compare to the dopamine group, the incidence rate of hypotension was lower in the ephedrine group(43.1%vs 69.2%,χ2=7.06,P=0.00). The p H value of umbilical artery and 1 min Apgar score of neonate in the ephedrine group was lower compare with that in the dopamine group[(7.22±0.03)vs(7.27±0.06),t=0.62, P=0.02], there are no significant difference of 5min Apgar score in the two groups. Conclusion Compared with dopamine, ephedrine is a useful drug in the prevention of hypotension during combined spinal and epidural anesthesia(CSEA)for cesarean delivery and there are no significant differences of adverse effects of dopamine and ephedrine. Ephedrine has transient effect on the neonate, while the effect of dopamine is minor. Key words: Cesarean section; Anesthesia; Ephedrine; Dopamine

Normal value of pulsatility index of umbilical artery in second and third trimester of pregnancy

This cross sectional study was carried out on 60 pregnant Bangladeshi women in the department of Radiology and Imaging, BIRDEM for measurement of Pulsatility Index (PI) of umbilical artery of their fetuses by duplex colour Doppler sonography during 2nd and 3rd trimester of pregnancies. Considering total 2nd and 3rd trimesters the mean PI value of umbilical artery was 1.24 (SD +/- 0.27). While considering the gestational in separate trimesters, study showed that the value of PI in 2nd trimester was 1.33 (SD +/- 0.29) and in 3rd trimester PI was 1.18 (SD +/- 0.25). Paired t test shows there was a highly significant (t = 35.79, df = 59, Level of significance = 0.001) difference between mean values of PI in different gestational ages. It was observed that there was gradual decrease of PI value with increase of gestational age (r = -0.207) but this decrease of PI was not statistically significant (p = 0.113). Regression analysis between dependent PI value and independent gestational age showed linear negative relationship but this was not statistically significant (p = 0.11). This study revealed that the Pulsatility index of umbilical artery was decreased with increase of gestational age from 2nd to 3rd trimester.

Could adverse perinatal outcome be predicted from intrapartum umbilical vessels Doppler in women with abnormal cardiotocography?

Abstract Objectives To evaluate the value of umbilical artery and umbilical vein Doppler study in predicting adverse perinatal events in low risk women with abnormal cardiotocography during labor. Design Prospective cohort study. Setting Emergency unit of obstetrics & gynecology department, Royal Commission hospital, El Gubail Industrial City, Saudi Arabia. Population Sixty-six women with uncomplicated pregnancy were classified according to cardiotocography (CTG) findings during the active phase of labor into, 33 cases with normal CTG (group 1) and 33 cases with pathological CTG (group 2). Colour Doppler study of the umbilical artery (UA) and umbilical vein (UV) were performed for both groups and the results were correlated to perinatal outcome. Main outcome measures Meconium stained amniotic fluid, emergency Cesarean deliveries for suspected fetal distress. Apgar score at 1 and 5 min, UA and UV cord blood pH, and the need for neonatal intensive care unit (NICU) admission. Results In the pathological CTG group two (6.1%) cases had high UA Doppler indices with no adverse perinatal outcome, while 13 (39.4%) cases showed UV pulsations of them 12 (92.3%) cases underwent emergency cesarean section for fetal distress, 5 (38.4%) cases delivered babies with UV pH Normal UA Doppler indices and no UV pulsations were seen in all cases with normal CTG group with no adverse perinatal outcome. Conclusion UV Doppler study in combination with CTG monitoring as a part of the intra partum fetal surveillance in low risk pregnancy might give additional useful information about fetal condition and suspected intrapartum fetal hypoxia.

Fetal Pulmonary Arterial Vascular Impedance Reflects Changes in Fetal Oxygenation at Near-Term Gestation in a Nonhuman Primate Model

We tested the hypothesis that fetal pulmonary arterial circulation reacts to changes in fetal oxygenation status at near-term gestation. A total of 20 rhesus macaques underwent fetal Doppler ultrasonography at near-term gestation. Right pulmonary artery (RPA), umbilical artery (UA), ductus arteriosus (DA), and ductus venosus (DV) blood velocity waveforms were obtained, and pulsatility index (PI) values were calculated. Fetal right and left ventricular cardiac outputs were determined. Ultrasonographic data were collected during 3 maternal oxygenation states: room air (baseline), hyperoxemia, and hypoxemia. Fetal RPA PI values increased (P < .05) during maternal hypoxemia and decreased (P < .05) during maternal hyperoxemia, compared with baseline. Maternal hyperoxemia increased (P < .05) DA PI values from baseline. Fetal cardiac outputs, UA, and DV PI values were not affected. Our results demonstrate that at near-term gestation, fetal pulmonary arterial circulation is a dynamic vascular bed that reflects acute and short-term changes in fetal oxygenation.

Expression and significance of AT1-AA and ET1 in materal peripheral blood, umbilical cord blood and placenta in preeclampsia

To investigate the expression of autoantibodies to the angiotensin II type I receptor (AT1-AA) and endothelin-1 (ET-1) in pregnant women's blood and explore their correlation with the pathogenesis of preeclampsia. Ninety pregnant women who delivered from June 2011 to December 2011 in the First Affiliated Hospital of Zhengzhou University were chosen as the study objects. They were divided into mild preeclampsia group (n = 30), severe preeclampsia group (n = 30) and normal group (control group, n = 30). The levels of AT1-AA and ET1 in maternal peripheral blood and umbilical cord blood were detected by ELISA, and the mRNA expression levels of AT1-AA and ET1 in placenta tissues were determined by reverse transcription (RT) PCR. Moreover, the correlation clinical indexes were detected and analysed. (1) The levels of AT1-AA and ET1 in maternal peripheral blood of preeclampsia [mild group: (114 ± 19) ng/L and (31 ± 9) ng/L, severe group: (145 ± 15) ng/L and (38 ± 10) ng/L] were both significantly higher than that of control group [(59 ± 5) ng/L, (17 ± 4) ng/L]. In addition, compared with mild group, the levels of AT1-AA and ET1 in severe group were significantly higher (P < 0.05). (2) The levels of AT1-AA and ET1 in umbilical cord blood of preeclampsia [mild group: (105 ± 14) ng/L and (35 ± 6) ng/L, severe group: (118 ± 14) ng/L and (40 ± 5) ng/L] were significantly higher than that of control group [(61 ± 12) ng/L, (24 ± 5) ng/L]. In addition, compared with mild group, the levels of AT1-AA and ET1 in severe group were significantly higher (P < 0.05). (3) The mRNA expression levels of AT1-AA and ET1 in placenta tissues of mild group (0.313 ± 0.039, 0.296 ± 0.028) and severe group (0.568 ± 0.052, 0.577 ± 0.046) were significantly higher than that in control group (0.198 ± 0.017, 0.137 ± 0.012), and the levels in severe group were significantly higher than that in mild group (P < 0.05). (4) There was an evident positive correlation between AT1-AA and ET1 levels of preeclampsia women's peripheral blood, umbilical cord blood and placenta (P < 0.05). (5) The level of AT1-AA in umbilical cord blood of preeclampsia pregnant women was positively correlated with S/D value of umbilical artery (P < 0.05), and negatively correlated with the weight of the birth and the placental (P < 0.05). The AT1-AA in the blood of pregnant women plays an important role in promoting the generation and development of preeclampsia by increasing the ET1 secretion.

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.

A multi-center study to evaluate the dynamic changes of uterine artery and umbilical artery flow in a normal pregnancy and hypertensive disorders in pregnancy

To investigate the dynamic changes of uterine artery and umbilical artery in the first, second, and third trimester of normal pregnancy and hypertensive disorders in pregnancy (HDP). A multi-center prospective study was conducted on 1098 women with normal singleton pregnancies at the first prenatal visit in the Second West China Hospital of Sichuan University, First Affiliated Hospital with Nanjing Medical University, Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University, Wuhan Union Hospital Affiliated to Medical School of Huazhong University of Science and Technology and Renji Hospital Affiliated to Medical School of Shanghai Jiao Tong University from April 2005 to July 2006, with the average age of (28.3 ± 3.3). The pulsatility indices (PI), resistance indices (RI) and systolic to diastolic velocity ratios (S/D) of uterine artery and umbilical artery were measured for all subjects in the first (10th-14th gestational weeks), second (20th-26th gestational weeks) and third trimester (30th-36th gestational weeks), respectively. In this longitudinal study, women who developed HDP were classified into HDP group, and the rest into normal pregnancy group. (1) Among the 1098 pregnant women, 44 developed HDP during the index pregnancy, including 20 gestational hypertension, 15 mild pre-eclampsia and 9 severe pre-eclampsia, giving an incidence of 4.17%, and the rest 1054 were normal until delivery. (2) In the normal pregnancy group, the RI, PI and S/D of uterine artery were decreased with the progress of pregnancy (RI: 0.64, 0.57, 0.50; PI: 1.24, 0.98, 0.80; S/D: 3.26, 2.58, 2.20; P < 0.01). However, the above indices showed an increasing trend with the increase of gestations in the HDP group (RI: 0.55, 0.67, 0.64; PI: 1.22, 1.36, 1.20; S/D: 3.18, 3.41, 3.05; P < 0.01). In the second and third trimester, the RI, PI and S/D of uterine artery in the HDP group were higher than those in the normal pregnancy group (P < 0.01). (3) In the normal pregnancy group, the RI, PI and S/D of the umbilical artery decreased from the second to the third trimester (RI: 0.71 and 0.58; PI: 1.16 and 0.87; S/D: 3.58 and 2.48; P < 0.01). However, no significant difference was found in the RI, PI and S/D value of umbilical artery in the second and third trimester between the normal and HDP group (RI: 0.71 and 0.63; PI: 1.20 and 0.95; S/D: 3.71 and 2.69; P > 0.05, respectively), despite the decreasing trend in the HDP group. In uncomplicated pregnancies, the blood flow resistance of uterine artery decreases and the end-diastolic blood flow of uterine artery increases with the progress of pregnancy. However, in pregnant women with HDP, the blood flow resistance of uterine artery increases significantly with the increase of gestations which shows significant difference to that in normal pregnancies. The blood flow resistance of umbilical artery decreases in both normal and HDP pregnant women with the increasing gestational age.

Characterization of RAGE, HMGB1, and S100β in Inflammation-Induced Preterm Birth and Fetal Tissue Injury

Immune activation represents an adaptive reaction triggered by both noxious exogenous (microbes) and endogenous [high mobility group box-1 protein (HMGB1), S100 calcium binding proteins] inducers of inflammation. Cell stress or necrosis lead the release of HMGB1 and S100 proteins in the extracellular compartment where they act as damage-associated molecular pattern molecules (or alarmins) by engaging the receptor for advanced glycation end-products (RAGE). Although the biology of RAGE is dictated by the accumulation of damage-associated molecular pattern molecules at sites of tissue injury, the role of RAGE in mediating antenatal fetal injury remains unknown. First, we studied the relationships at birth between the intensity of human fetal inflammation and sRAGE (an endogenous RAGE antagonist), HMGB1, and S100beta protein. We found significantly lower sRAGE in human fetuses that mounted robust inflammatory responses. HMGB1 levels correlated significantly with levels of interleukin-6 and S100beta in fetal circulation. We then evaluated the levels and areas of tissue expression of RAGE, HMGB1, and S100beta in specific organs of mouse fetuses on E16. Using an animal model of endotoxin-induced fetal damage and preterm birth, we determined that inflammation induces a significant change in expression of RAGE and HMGB1, but not S100beta, at sites of tissue damage. Our findings indicate that RAGE and HMGB1 may be important mediators of cellular injury in fetuses delivered in the setting of inflammation-induced preterm birth.

Expression and significance of Rho-associated protein kinase II in preeclamptic placenta and umbilical artery

To investigate the expression and significance of Rho-associated protein kinase II (Rock II) in preeclamptic placenta and umbilical artery. Semiquantitative RT-PCR and Western blot were used to investigate the expression of Rock II mRNA and Rock II protein in placenta and umbilical artery from 35 women with moderate preeclampsia (MPE group), 38 women with severe preeclampsia (SPE group) and 45 normal third trimester pregnant women (control group), the S/D value of umbilical artery was examined by ultrasound. (1) The expression of Rock II mRNA of placenta in MPE group (0.82+/-0.14) and SPE group (0.93+/-0.13) were significantly higher than that in control group (0.70+/-0.12, P<0.01). The expression of Rock II protein of placenta in MPE group (0.79+/-0.15) and SPE group (0.92+/-0.12) were significantly higher compared with control group (0.68+/-0.11, P<0.01). The expression of Rock II mRNA and protein of placenta in SPE group were higher compared with MPE group (P<0.01). (2) The expression of Rock II mRNA of umbilical artery in MPE group (0.69+/-0.13) and SPE group (0.55+/-0.12) were significantly lower than that in control group (0.76+/-0.10, P<0.01). The expression of Rock II protein of umbilical artery in MPE group (0.68+/-0.10) and SPE group (0.51+/-0.12) were lower compared with control group (0.75+/-0.13, P<0.01). The expression of Rock II mRNA and protein of umbilical artery in SPE group were significantly lower compared with MPE group (P<0.01). (3) There were no correlations between the expression of Rock II mRNA and protein in placenta and umbilical artery and the S/D value and birth weight (P>0.05). The upregulated expression of Rock II in placentas and downregulated expression in umbilical artery may be a compensation in preeclampsia.

The relationship between human fetal cardiovascular hemodynamics and serum erythropoietin levels in growth-restricted fetuses

We hypothesized that in growth restricted fetuses, erythropoietin (EPO) secretion is increased in proportion to the severity of cardiovascular compromise. Thirty-eight growth restricted fetuses underwent Doppler ultrasonography of cardiovascular hemodynamics. An umbilical artery (UA) blood sample was taken at delivery for EPO analysis. Group 1 fetuses (n=9) had normal UA and ductus venosus (DV) velocimetries. Group 2 fetuses (n=18) showed an abnormal UA and a normal DV velocimetry. Group 3 fetuses (n=11) had abnormal UA and DV velocimetries. Normal EPO values were determined in 19 uncomplicated pregnancies (control group). In group 3, EPO levels were higher (P<.05) than in groups 1 and 2. All fetuses in group 3 had EPO concentrations above the 90th percentile EPO value in the control group. The corresponding incidences were 44% and 50% in groups 1 and 2. Fetuses with retrograde aortic isthmus net blood flow had greater (P<.001) EPO levels than fetuses with antegrade net blood flow. Descending aorta, UA, DV and left hepatic vein pulsatility index values correlated significantly with EPO concentrations. In fetal growth restriction, serum EPO concentration is increased in proportion to the severity of fetal cardiovascular compromise. Furthermore, in fetuses with retrograde aortic isthmus net blood flow, EPO levels are increased.

Middle cerebral artery peak systolic velocity: a new Doppler parameter in the assessment of growth‐restricted fetuses

The aims of this study were to determine if there is a relationship between middle cerebral artery (MCA) peak systolic velocity (PSV) and perinatal mortality in preterm intrauterine growth-restricted (IUGR) fetuses, to compare the performance of MCA pulsatility index (PI), MCA-PSV and umbilical artery (UA) absent/reversed end-diastolic velocity (ARED) in predicting perinatal mortality, to determine the longitudinal changes that occur in MCA-PI and MCA-PSV in these fetuses, and to test the hypothesis that MCA-PSV can provide additional information on the prognosis of hypoxemic IUGR fetuses. This was a retrospective cross-sectional study of 30 IUGR fetuses (estimated fetal weight < 3(rd) percentile; UA-PI > 95% CI) in which the last MCA-PI, MCA-PSV and UA values were obtained within 8 days before delivery or fetal demise. Among the 30 fetuses, there were 10 in which at least three consecutive measurements were performed before delivery and these were used for a longitudinal study. MCA-PSV and MCA-PI values were plotted against normal reference ranges and were considered abnormal when they were above the MCA-PSV or below the MCA-PI reference ranges. Gestational age at delivery ranged between 23 + 1 and 32 + 5 (median, 27 + 6) gestational weeks. Birth weight ranged from 282 to 1440 (median, 540) g. There were 11 perinatal deaths. Forward stepwise logistic regression indicated that MCA-PSV was the best parameter in the prediction of perinatal mortality (odds ratio, 14; 95% CI, 1.4-130; P < 0.05) (Nagerlke R(2) = 31). In the 10 fetuses studied longitudinally, an abnormal MCA-PI preceded the appearance of an abnormal MCA-PSV. In these fetuses, the MCA-PSV consistently showed an initial increase in velocity; before demise or the appearance of a non-reassuring test in seven fetuses, there was a decrease in blood velocity. The MCA-PI presented an inconsistent pattern. In IUGR fetuses, the trends of the MCA-PI and MCA-PSV provide more clinical information than does one single measurement. A high MCA-PSV predicts perinatal mortality better than does a low MCA-PI. We propose that MCA-PSV might be valuable in the clinical assessment of IUGR fetuses that have abnormal UA Doppler.

P10.25: Doppler, NST, and biophysical profile changes in severe IUGR—a longitudinal prospective randomized study

growth and either normal (small for gestational age or SGA) or abnormal (intrauterine growth restricted or IUGR) Doppler studies in the umbilical artery (UA). Pulsatility index (PI) of the AoI was calculated in all groups at the moment of diagnosis. Results: AoI PI was directly related to the severity of the placental insufficiency. Mean UA and AoI PI values, gestational age at delivery and birth weight in both control and study groups are compared in the table. Among the IUGR fetuses the cases showing retrograde net blood flow in the AoI had a 62.5% (5/8) perinatal mortality rate.

P80Combined assessment of the fetal distress in diabetic pregnancy class R/F using uterine, middle cerebral, umbilical artery blood flow and fetal heart rate monitoring

BackgroundPregnacies complicated by diabetes mellitus cl.R/F are in higher risk of placentae insufficiency and poor perinatal outcome.MethodsWe have investigated 15 diabetic pregnant women of class R/F after 26 weeks of pregnancy. We observed waveform ‘notch’ in ascending uterine artery. Fetal distress was diagnosed when, in the nst silent oscilation or late decelarations appeared. Pathological blood flow in term pregnancy was diagnosed when RI and PI was abnormal and cerebro‐placental ratio was above 1. AEDF and REDF were assessed as fetal distress. Newborns were estimated by Apgar score and pH value of umbilical artery. The mean diurnal glycemia ranged 110 mg/dl, and the HbA1c 6.2%, 8.0%.ResultsPathological condition acc. to the AS and pH A.umb. manifested 75% newborns, but acc. only to pH A.umb.values 15% of them. Positive predictive value of NST in fetal distress detection was 66%, of the DV 53%, uterine artery ‘notch’ 66% when neonates condition was analysed by using AS and pH. The highest (80%) PPV was achieved all methods. False positive results in NST analysis were found in 19.8% of cases. False negative results was for methods together in 6.6%. When the neonates condition was analysed only by using pH A.umb.value, the PPV for NST was 66%, for DV 73%, for ‘notch’ 73% and for all methods together 86%. False positive results for all methods NST, DV, ‘notch’: and for all methods tohether, achieved the following values: 26%, 19.8%, 19.8% and 26%. False negative result in all methods was 6.6%.ConclusinsBlood flow measurements in fetal and maternal circulatory circles combined with FHR monitoring reaches very high prognostic values in detection of the fetal distress.

Cord blood oxygen saturation in vigorous infants at birth: what is normal?

To define the normal ranges of umbilical cord blood oxygen saturation (SaO2) and acid-base status at birth and to evaluate the effect of gestational age on cord blood values in vigorous newborn infants following spontaneous vaginal birth from a vertex position. Prospective study. Department of Obstetrics and Gynaecology, University of Graz, Austria. Cord blood samples from 1281 vigorous newborn infants. Cord blood sampling was performed following on newborn infants following spontaneous vaginal birth in a vertex position. SaO2 was measured directly by a spectrophotometer and pH, base excess, pCO2 and pO2 by a pH/blood-gas analyser. Infants with a 5-minute Apgar score > or = 7 were considered vigorous. Subgroups were classified according to the gestational age: preterm, term and post-term (< 37, 37-42 and > 42 weeks, respectively). The median umbilical artery SaO2 was 24.3% and the 2.5th centile was as low as 2.7%. The median umbilical artery values were pH = 7.25, base excess = -4.3 mmol/L and pO2 = 16 mmHg. The 2.5th centiles were 7.08, -11.1 mmol/L and 5 mmHg, respectively. The median umbilical artery pCO2 was 50 mmHg and the 97.5th centile was 75 mmHg. The mean umbilical artery and vein SaO2 values were not significantly influenced by gestational age. The umbilical artery SaO2 and base excess values were strongly skewed. The mean umbilical artery pH values in preterm infants were higher than in other subgroups. The mean umbilical artery and vein base excess values were lower in post-term newborn infants than in other subgroups. The physiological range of oxygen saturation in umbilical cord of vigorous newborn infants at birth is wide and skewed. In contrast to pH and base excess, umbilical cord blood oxygen saturation is not influenced significantly by gestational age at birth.

Value of umbilical artery and vein levels of interleukin-6 and soluble intracellular adhesion molecule-1 as predictors of neonatal hematologic indices and suspected early sepsis.

This study was designed to evaluate the relationship of suspected early neonatal sepsis to umbilical artery and vein levels of interleukin-6 (IL-6) and soluble intracellular adhesion molecule-1 (sICAM-1). Umbilical artery and vein samples from 17 preterm and 6 term pregnancies were assayed for IL-6 (pg/ml) and sICAM-1 (ng/ml). Neonates were categorized as having probable or suspected sepsis vs. no sepsis within 3 days of birth. Levels of IL-6 and sICAM-1 were evaluated based on sepsis status. Neonatal hematologic parameters were correlated with umbilical artery (ua) and vein (uv) levels of IL-6 and sICAM-1. Sensitivity, specificity, positive and negative predictive values for detecting neonates having probable or suspected early sepsis were calculated. There were significant differences of IL-6 levels between suspected sepsis and no infants in the umbilical artery (P < 0.002) and vein (P < 0.0001). The sensitivity, specificity, positive and negative predictive values for detection of suspected early neonatal sepsis using umbilical artery IL-6 levels > 7 pg/ml were 88.5%, 66.6%, 58.8%, 91%, and for umbilical vein levels > 7 pg/ml these values were 88.5%, 93.3%, 88.5%, and 93.3%. Umbilical artery and vein IL-6 levels correlated with both absolute band counts and immature/total neutrophil ratios. sICAM-1 levels were not affected by designated sepsis status. Umbilical cord blood IL-6 (but not sICAM-1) is potentially useful as a marker for suspected early neonatal sepsis.

Value of Umbilical Artery and Vein Levels of Interleukin-6 and Soluble Intracellular Adhesion Molecule-1 as Predictors of Neonatal Hematologic Indices and Suspected Early Sepsis

This study was designed to evaluate the relationship of suspected early neonatal sepsis to umbilical artery and vein levels of interleukin-6 (IL-6) and soluble intracellular adhesion molecule-1 (sICAM-1). Umbilical artery and vein samples from 17 preterm and 6 term pregnancies were assayed for IL-6 (pg/ml) and sICAM-1 (ng/ml). Neonates were categorized as having probable or suspected sepsis vs. no sepsis within 3 days of birth. Levels of IL-6 and sICAM-1 were evaluated based on sepsis status. Neonatal hematologic parameters were correlated with umbilical artery (ua) and vein (uv) levels of IL-6 and sICAM-1. Sensitivity, specificity, positive and negative predictive values for detecting neonates having probable or suspected early sepsis were calculated.There were significant differences of IL-6 levels between suspected sepsis and no sepsis infants in the umbilical artery (P < 0.002) and vein (P < 0.0001). The sensitivity, specificity, positive and negative predictive values for detection of suspected early neonatal sepsis using umbilical artery IL-6 levels >7 pg/ml were 88.5%, 66.6%, 58.8%, 91%, and for umbilical vein levels >7 pg/ml these values were 88.5%, 93.3%, 88.5%, and 93.3%. Umbilical artery and vein IL-6 levels correlated with both absolute band counts and immature/total neutrophil ratios. sICAM-1 levels were not affected by designated sepsis status.Umbilical cord blood IL-6 (but not sICAM-1) is potentially useful as a marker for suspected early neonatal sepsis.