Umbilical Cord Base Excess Research Articles

Safety and Efficiency of Low-Dose Spinal Analgesia Compared to Epidural Analgesia in Treatment of Pain during Labour: A Case Control Study.

The epidural catheter for analgesia has been used for decades and has become the gold standard in pain therapy for pregnant women in labour. However, procedural parameters such as time to pain relief and duration to implementation pose hurdles for patients shortly before delivery. Low-dose spinal analgesia (LDSA) is an alternative procedure that was investigated in the study with regard to patient satisfaction and complication rates compared to epidural catheter. In a retrospective monocentric study, a total of 242 patients receiving low-dose spinal analgesia or epidural catheters were evaluated using propensity score matching. Subjective patient satisfaction as well as complication rates were primarily analysed. We hypothesise that LDSA is a safe procedure and provides a similar level of satisfaction compared with the epidural catheter. For this purpose, both procedures were performed according to in-house standards and the patients were interviewed afterwards. Patients who required surgical delivery were excluded to prevent bias. The LDSA was rated on average as very good [1.09 ± 0.311 vs. 1.07 ± 0.431] in terms of satisfaction by the patients compared to the epidural catheter without showing a significant difference (p = 0.653). Complications were in the low single-digit non-significant range for both procedures [6 (5%) vs. 7 (6%); p = 0.776]. The evaluation showed more perineal tears I° and II° in the low-dose spinal analgesia group [I°: 28 (23%) vs. 3 (2%); p < 0.001-II°: 30 (25%) vs. 2 (2%); p < 0.001]. Neonatal parameters differed significantly only in umbilical cord base excess and umbilical cord venous pH [-5.40 vs. -6.40; p = 0.005]. LDSA represents a low complication procedure for patients at the end of labour with a high satisfaction level. With the LDSA in the repertoire of pain relief during childbirth, it is possible to also achieve pain reduction for women with deliveries of high velocity without compromising patient satisfaction or perinatal morbidity.

Associations between piglet umbilical blood hematological criteria, birth order, birth interval, colostrum intake, and piglet survival.

A total of 656 pigs (623 live-born and 33 stillborn) from 43 sows were used to evaluate hematological criteria at birth and their association with piglet survival. At birth of each piglet, birth time and order within the litter, weight, umbilical cord status (intact or ruptured) and whether the pig was live-born or stillborn were recorded. A 200µL sample of blood from the umbilical cord was collected and immediately analyzed for concentrations of glucose, oxygen partial pressure (pO2), carbon dioxide partial pressure (pCO2), pH, base excess (BE), bicarbonate (HCO3), saturated oxygen (sO2), total carbon dioxide (TCO2), sodium, potassium, ionized calcium (iCa), hematocrit (Hct), and hemoglobin (Hb) on a hand held iStat portable clinical analyzer (iStat Alinity, Abbott Point of Care Inc., Princeton, NJ). Piglets were categorized into quartiles based on birth order and cumulative birth interval (CumBI). Live-born pigs had higher (P < 0.01) umbilical cord blood pH, HCO3, BE, sO2, TCO2, and birth weight compared with stillborn pigs, but lower (P < 0.01) pCO2, K, iCa, and glucose compared with stillborn pigs. Pigs with intact umbilical cords at birth were associated with higher (P < 0.01) blood pH, HCO3, BE, and TCO2 compared with piglets born with a ruptured umbilical cord. Pigs with intact umbilical cords were associated with lower (P < 0.01) Hct and Hb concentrations and born earlier (P < 0.01) in the birth order compared with pigs born with a ruptured umbilical cord. Pigs that did not survive to weaning had lower (P < 0.01) umbilical cord blood pH, HCO3, BE, sO2, TCO2, Na, glucose, and birth weight, and 24 hr weight compared with pigs alive at weaning. Pigs born in the first quartile for CumBI had higher (P <0.05) pH compared with pigs in the other three quartiles. Umbilical cord blood HCO3, BE, and TCO2 decreased (P <0.05) with each change in CumBI quartile from first to last. Blood glucose was lowest (P <0.05) in pigs born before 44 min and highest in pigs born after 164 min. Umbilical cord blood pH, HCO3, BE, TCO2, Na, glucose, Hct, and Hb were positively associated (P <0.001) with colostrum intake, indicating increased blood values resulted in higher colostrum intake. Although a pig may be live-born, their survival to 24 hr and to weaning is reduced when blood pH, HCO3, BE, and sO2 are lower reiterating the importance of management practices that can reduce the birth interval between pigs and the number of pigs experiencing moderate to severe hypoxia.

Umbilical Cord Arterial Blood Gas and Apgar Score: Who Is at Higher Risk?

Background: Fetal asphyxia and the consequent neurological damages could be avoided if the risk factors are controlled at earlier stages. Umbilical cord arterial blood gas (UCABG) seems to be related to the Apgar scores, as well as the neonatal morbidity and mortality rates. Therefore, we designed this study to assess the correlation between the Apgar score and UCABG in Northeast of Iran. Methods: This case-control study evaluated 438 term newborns and 62 preterm infants born during 2012-2013. Peripartum asphyxia, admission in the neonatal intensive care unit, and death were recorded as outcome measures. All the data were analyzed using the t-test and logistic regression analysis. Results: Mild to moderate acidemia (pH=7-7.2) was reported in 9.6% and severe acidemia (PH<7) was observed in 1% of the participants. Multivariate analysis showed that aspiration of amniotic fluid, umbilical cord pH ≤ 7.2, umbilical cord base excess, and being preterm could be considered as the predictors of lower first-minute Apgar score. Conclusion: Umbilical cord blood gas measurement is a useful tool to detect the neonates who are at higher risk of low Apgar.

Corrélation entre prélèvements au scalp fœtal et prélèvements artériels au cordon

The objective was to evaluate the correlation between fetal scalp base excess (BE) and umbilical cord BE. Respective value of fetal scalp pH, BE and lactate for the prediction of neonatal metabolic acidosis were also evaluated. A retrospective monocentric study was conducted in a French tertiary care academic maternity. All the patients who had a fetal scalp sampling during labor in 2010, less than 90 minutes before delivery were included. Fetal heart rate abnormalities (FHRA) were classified by degree of severity, according to the French guidelines. The differences between fetal scalp samples and umbilical cord samples over time and in relation with the type of FHRA were analyzed for pH and BE. The differences between fetal scalp pH and cord pH over time and in relation with scalp BE were analyzed. The correlation between fetal scalp samples and cord samples for pH, BE and lactate was estimated. Receiver operating characteristics (ROC) curves for fetal scalp pH, lactate and BE to predict umbilical cord pH under 7.20 were calculated. Seventy-one cases were included. The difference between fetal scalp sample and cord sample was lower when the sample was made closest to delivery both for pH and BE. The gravity of FHRA was not predictive of a faster decrease of pH or BE over time. The correlation was significant for pH (r=0.23, p=0.03) between scalp samples and cord samples, as for BE (r=0.49, p=0.001) and lactate (r=0.52, p=0.001). The ROC curves for pH, BE and lactate displayed a similar pattern. Fetal scalp and umbilical cord samples, for pH, BE and lactate were significantly correlated but their respective predictive value for cord pH less or equal to 7.20 was poor.

Intrapartum Electronic Fetal Heart Rate Monitoring and the Prevention of Perinatal Brain Injury

Electronic fetal heart rate monitoring (EFM) is the most widely used method of intrapartum surveillance, and our objective is to review its ability to prevent perinatal brain injury and death. Studies that quantified intrapartum EFM and its relation to specific neurologic outcomes (seizures, periventricular leukomalacia, cerebral palsy, death) were eligible for inclusion. MEDLINE was searched from 1966 to 2006 for studies that examined the relationship between intrapartum EFM and perinatal brain injury using these MeSH and text words: "cardiotocography," "electronic fetal monitoring," "intrapartum fetal heart rate monitoring," "intrapartum fetal monitoring," and "fetal heart rate monitoring." This search strategy identified 1,628 articles, and 41 were selected for further review. Articles were excluded for the following reasons: in case reports, letters, commentaries, and review articles, intrapartum EFM was not quantified, or specific perinatal neurologic morbidity was not measured. Three observational studies and a 2001 meta-analysis of 13 randomized controlled trials were selected for determination of the effect of intrapartum EFM on perinatal brain injury. Electronic fetal monitoring was introduced into widespread clinical practice in the late 1960s based on retrospective studies comparing its use to historical controls where auscultation was performed in a nonstandardized manner. Case-control studies have shown correlation of EFM abnormalities with umbilical artery base excess, but EFM was not able to identify cerebral white matter injury or cerebral palsy. Of 13 randomized controlled trials, one showed a significant decrease in perinatal mortality with EFM compared with auscultation. Meta-analysis of the randomized controlled trials comparing EFM with auscultation have found an increased incidence of cesarean delivery and decreased neonatal seizures but no effect on the incidence of cerebral palsy or perinatal death. Although intrapartum EFM abnormalities correlate with umbilical cord base excess and its use is associated with decreased neonatal seizures, it has no effect on perinatal mortality or pediatric neurologic morbidity.