Umbilical Cord Gas Research Articles

Atypical decelerations: do they matter?

Objective: To estimate the association between atypical variable decelerations and neonatal acidemia.Method: We conducted a one-year case-control study comparing the last thirty minutes before delivery of fetal heart rate tracings of 102 acidemic neonates (umbilical arterial cord gas pH ≤ 7.10) with 100 non-acidemic controls (umbilical arterial cord gas pH > 7.10). Incidence of atypical features and total number of decelerations, number of atypical decelerations, number of slow return decelerations and number of decelerations with loss of moderate variability during deceleration were extracted. We estimated the association between atypical features, neonatal acidemia and neonatal morbidity.Results: Acidemic neonates showed a larger number of atypical decelerations (4 [0-12] vs. 3 [0-10]), “slow return” decelerations (4 [0-11] vs. 1 [0-10]) and decelerations with non-moderate variability (0[0-12] vs. 0 [0-6]) compared to non-acidemic controls. “Slow return” was significantly associated with an increased risk of acidemia at birth (OR 4.46; CI 95%: 2.18 – 9.15) “Slow return” was the most discriminating feature between groups with an AUC: 0.745.Conclusion: Certain atypical features, as “slow return” and loss of moderate variability within decelerations are associated with neonatal acidemia. “Slow return” could help in the gradation of acidemia risk levels, as an indicator of gravity.

Newborn outcomes in british columbia after caesarean section for non-reassuring fetal status.

To assess the incidence in British Columbia of severe morbidity in neonates delivered by Caesarean section for non-reassuring fetal status, and to examine the accuracy of Apgar score and umbilical cord gas values in predicting severe neonatal morbidity. We assessed rates of hypoxic ischemic encephalopathy, NICU admission, and ventilator days, individually and as a composite outcome with neonatal death, among a total of 8466 term singletons delivered by Caesarean section for non-reassuring fetal status between January 1, 2007, and December 31, 2011. We calculated the predictive accuracy of Apgar scores and umbilical cord blood gas values using the area under the receiver operating characteristic (ROC) curve and the sensitivity and specificity for each outcome. The incidence of Apgar score at one minute < 4 was 8.0%, and for Apgar score at five minutes < 4 it was 0.6%. The incidence of umbilical cord pH < 7.10 was 6.5%, and for base-excess < -12 it was 2.9%. Apgar score at one minute < 7 had the greatest predictive accuracy for the composite outcome (81% for both sensitivity and specificity). The area under the ROC curve for Apgar score at one minute and at five minutes, umbilical cord pH, and base-excess was 0.87, 0.86, 0.76, and 0.78, respectively. The incidence of abnormal Apgar score and abnormal umbilical cord gas values is very low among neonates in British Columbia delivered by Caesarean section for non-reassuring fetal status. Apgar score at one minute < 7 is a good predictor of severe neonatal morbidity. Electronic fetal monitoring remains a non-specific method for detection of fetal compromise in the intrapartum period.

511: Neonatal acidemia in neonates with 5-minute apgar scores greater than 7 – What are the outcomes?

ObjectiveIt is common to assess neonatal cord gases in the setting of an Apgar score of 6 or less. However, cases of neonatal acidemia may be missed with such an approach. In a setting of universal umbilical cord gases, we sought to ascertain the rates of neonatal acidemia, factors associated with increased risk, and outcomes associated with neonatal acidemia in neonates with 5-minute Apgar scores >7.Study DesignA retrospective cohort of all term, singleton, neonates with a 5-minute Apgar score>7 was designed. The incidence of umbilical artery pH<7.0, pH<7.1, base excess<-10, and base excess<-12 were examined overall and in association with several obstetric complications. Adverse neonatal outcomes were examined by the various acidemia groups as well. Chi-squared tests were utilized to compare proportions and potential confounders were controlled for using multivariable logistic regression.ResultsIn neonates with Apgar scores 7 or greater the overall incidence of an umbilical artery pH < 7.0 was 0.5%, pH<7.1 was 3.4%, base excess <-10 was 4.0%, and base excess <-12 was 1.4%. The rates of neonatal academia were greater in the setting of meconium, abruption, and cesarean delivery despite the normal 5-minute Apgar scores (Table 1, base excess data not shown). Additionally, pH<7 and pH<7.1 were associated with RDS, MAS, and NICU admissions. Base excess <-10 and -12 were associated with these outcomes plus neonatal sepsis.(Table 2)ConclusionView Large Image Figure ViewerDownload Hi-res image Download (PPT) ObjectiveIt is common to assess neonatal cord gases in the setting of an Apgar score of 6 or less. However, cases of neonatal acidemia may be missed with such an approach. In a setting of universal umbilical cord gases, we sought to ascertain the rates of neonatal acidemia, factors associated with increased risk, and outcomes associated with neonatal acidemia in neonates with 5-minute Apgar scores >7. It is common to assess neonatal cord gases in the setting of an Apgar score of 6 or less. However, cases of neonatal acidemia may be missed with such an approach. In a setting of universal umbilical cord gases, we sought to ascertain the rates of neonatal acidemia, factors associated with increased risk, and outcomes associated with neonatal acidemia in neonates with 5-minute Apgar scores >7. Study DesignA retrospective cohort of all term, singleton, neonates with a 5-minute Apgar score>7 was designed. The incidence of umbilical artery pH<7.0, pH<7.1, base excess<-10, and base excess<-12 were examined overall and in association with several obstetric complications. Adverse neonatal outcomes were examined by the various acidemia groups as well. Chi-squared tests were utilized to compare proportions and potential confounders were controlled for using multivariable logistic regression. A retrospective cohort of all term, singleton, neonates with a 5-minute Apgar score>7 was designed. The incidence of umbilical artery pH<7.0, pH<7.1, base excess<-10, and base excess<-12 were examined overall and in association with several obstetric complications. Adverse neonatal outcomes were examined by the various acidemia groups as well. Chi-squared tests were utilized to compare proportions and potential confounders were controlled for using multivariable logistic regression. ResultsIn neonates with Apgar scores 7 or greater the overall incidence of an umbilical artery pH < 7.0 was 0.5%, pH<7.1 was 3.4%, base excess <-10 was 4.0%, and base excess <-12 was 1.4%. The rates of neonatal academia were greater in the setting of meconium, abruption, and cesarean delivery despite the normal 5-minute Apgar scores (Table 1, base excess data not shown). Additionally, pH<7 and pH<7.1 were associated with RDS, MAS, and NICU admissions. Base excess <-10 and -12 were associated with these outcomes plus neonatal sepsis.(Table 2) In neonates with Apgar scores 7 or greater the overall incidence of an umbilical artery pH < 7.0 was 0.5%, pH<7.1 was 3.4%, base excess <-10 was 4.0%, and base excess <-12 was 1.4%. The rates of neonatal academia were greater in the setting of meconium, abruption, and cesarean delivery despite the normal 5-minute Apgar scores (Table 1, base excess data not shown). Additionally, pH<7 and pH<7.1 were associated with RDS, MAS, and NICU admissions. Base excess <-10 and -12 were associated with these outcomes plus neonatal sepsis.(Table 2) Conclusion

Strip of the Month: June 2014

Electronic fetal monitoring is a popular technology used to establish fetal well-being. Despite its widespread use, terminology used to describe patterns seen on the monitor has not been consistent until recently. In 1997, the National Institute of Child Health and Human Development (NICHD) Research Planning Workshop published guidelines for interpretation of fetal tracings. This publication was the culmination of 2 years of work by a panel of experts in the field of fetal monitoring and was endorsed in 2005 by both the American College of Obstetricians and Gynecologists (ACOG) and the Association of Women’s Health, Obstetric and Neonatal Nurses. In 2008, ACOG, NICHD, and the Society for Maternal-Fetal Medicine reviewed and updated the definitions for fetal heart rate (FHR) patterns, interpretation, and research recommendations. The following is a summary of the terminology definitions and assumptions found in the 2008 NICHD workshop report. Normal values for arterial umbilical cord gas values and indications of acidosis are defined in Table 1. View this table: Table 1. Arterial Umbilical Cord Gas Values ### Assumptions From the NICHD Workshop ### Definitions #### Baseline FHR

Serum bile acids in intrahepatic cholestasis of pregnancy: Not just a diagnostic test

Serum bile acids in intrahepatic cholestasis of pregnancy: Not just a diagnostic test

Effects of Supplemental Oxygen on Maternal and Neonatal Oxygenation in Elective Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial

The use of supplemental oxygen in uncomplicated cesarean deliveries under spinal anesthesia has been thoroughly investigated during recent decades. The aim of this study was to determine the benefits for both mother and infant of administering supplemental, low-dose oxygen via a nasal cannula versus having no supplement (i.e., room air only). Healthy parturients at term undergoing elective cesarean section under spinal anesthesia were randomly allocated into two groups: an oxygen group (n = 170), who received 3 LPM oxygen via a nasal cannula; and a room-air group (n = 170), who were assigned to breathe room air. Maternal oxygen saturation was measured continuously by using pulse oximeter. The desaturation was determined by oxygen saturation <94% over 30 seconds. Umbilical cord gases and Apgar scores were collected followed delivery of the infant. All maternal desaturation events occurred in 12 parturients assigned to the room-air group. Most events were concurrent with hypotension. The umbilical venous partial pressure of oxygen was significantly higher in the oxygen group. The other blood gas measurements and Apgar scores were not significantly different between the two groups. Based on our findings, the use of supplemental oxygen could prevent maternal desaturation resulting from receiving sedation and intraoperative hypotension.

Strip of the Month: January 2014

Strip of the Month: January 2014

Strip of the Month: November 2013

Strip of the Month: November 2013

Strip of the Month: February 2013

Strip of the Month: February 2013

Umbilical cord gases in relation to the neonatal condition: the EveREst plot

ObjectiveTo validate umbilical arterial and venous pH and base deficit (pHUA, pHUV, BDUA, and BDUV, respectively), as well as venous-arterial pH differences, as measures of perinatal condition at birth (in relation to emergency intervention, resuscitation, facial mask, low Apgar, seizures, other cerebral problems or death); to investigate whether BDUA or pHUA better measures perinatal risk. Study designA novel method (Event Rate Estimate (EveREst) plots) was used to analyze cord blood gases and perinatal outcomes of 34,510 term singleton deliveries: cord blood gas values were grouped into exclusive quantiles (containing equal proportions of cases); the quantiles were plotted against per cent rates (event rates) for perinatal outcomes; the event rates for the different blood gases were compared using the χ2 test for difference of proportions. ResultsLow pHUA predicts poor perinatal outcome better than or comparably to high BDUA: pHUA is significantly better than BDUA for predicting low Apgar, resuscitation and facial mask (p<0.001, p<0.05, and p<0.001, respectively). For seizures and other cerebral problems, low pHUA is better than high BDUA but the difference is not statistically significant. For death, both measures perform equally well. Interventions for the specific reason of “fetal distress” increased as pHUA decreased but only where electronic fetal monitoring was used. In acidemic neonates (pHUA≤7.05, n=1752), significantly more cord prolapses and placenta abruptions were associated with large and small venous-arterial pH difference (pHVAD) respectively (p<0.01). ConclusionEveREst plots display clearly the diagnostic value of cord gases. They allow for the easy identification of background rates and increases above background, thresholds of interest, and comparison of the blood gas measures. Overall pHUA is the best umbilical blood measure of perinatal outcome. BDUA is comparable or inferior. Extremes of pHVAD (large or small) identify higher proportions of specific poor outcomes in acidemic neonates.

125: Adverse outcomes of teenage pregnancies

Jessica McPherson, Methodius Tuuli, Kimberly Roehl, Qiuhong Zhao, Anthony Odibo, Alison Cahill Washington University in St. Louis, Obstetrics and Gynecology, St. Louis, MO OBJECTIVE: Data on pregnancy outcomes of teenage women who deliver are limited. Given pelvic immaturity, there is concern for adverse events. The objective of this study was to compare pregnancy outcomes of women 18 years of age to those 18 years of age. STUDY DESIGN: This was a retrospective cohort study of all consecutive women who underwent labor between 2004 and 2008. Pregnancy outcomes including vaginal laceration, postpartum hemorrhage (PPH), shoulder dystocia, umbilical cord gas pH 7.2 or 7.05, and neonatal intensive care unit (NICU) admission in women 18 years of age were compared to women 18. A second analysis comparing only term deliveries was performed. Exclusion criteria included multiple gestations and congenital anomalies. Univariable and multivariable analyses were performed; logistic regression analyses were used to adjust for confounders. RESULTS: Of 8,390 women, 663 were 18 years of age. After adjusting for nulliparity, African American race, gestational hypertension, prior cesarean, and birthweight 4000 grams teen women were at an increased risk of vaginal laceration (aOR 1.59, CI 1.33-1.89), but there was no difference in postpartum hemorrhage, shoulder dystocia, umbilical cord gas pH 7.2 or pH 7.05, or NICU admission. There were 5,386 women who delivered at term, 500 were teenage women. After adjusting for nulliparity, African American race, gestational hypertension, gestational diabetes, prior cesarean, or birthweight 4000 grams there was no difference in laceration, postpartum hemorrhage, shoulder dystocia, umbilical cord gas pH 7.20 or pH 7.05. CONCLUSION: Our results suggest, while the teenage pelvis may not be mature, risks of postpartum hemorrhage, shoulder dystocia, abnormal umbilical cord gases, or NICU admission are similar when comparing women 18 years of age and those 18 years of age. There is, however, an increased risk of vaginal laceration in teenage women. 126 The impact of cervical length on the cost-effectiveness of vaginal progesterone as a preterm birth intervention Jessica Page, Jenna Emerson, Alison Cahill, Allison Allen, Jessica Fowler, Leonardo Pereira, Aaron Caughey Oregon Health & Science University, Obstetrics & Gynecology, Portland, OR, Washington University in St. Louis, Obstetrics & Gynecology, St. Louis, MO OBJECTIVE: To determine the cost-effectiveness of vaginal progesterone treatment for the prevention of preterm birth (PTB) over a wide range of short cervical length (CL) measurements. STUDY DESIGN: Decision-analytic models were built using TreeAge software comparing vaginal progesterone to no intervention at four different CL ranges (10-14mm, 15-19mm, 20-24mm, 25-29mm) measured once at 20-24 wks. Baseline preterm birth probabilities were adjusted to reflect the relative risk associated with each CL range as well as the relative risk reduction with vaginal progesterone treatment as estimated from the literature. The primary outcome was preterm birth at 37wks, with secondary outcomes of preterm birth 28wks and 35wks as well as neonatal death and cerebral palsy. The costeffectiveness threshold was set at $100,000/QALY (quality-adjusted life years). RESULTS: Vaginal progesterone was found to be an effective and inexpensive intervention for preterm birth. The greatest reduction in PTB was observed in the 10-14mm CL group with a cost difference of $9,136 ($17,136 vs. $26,272). Vaginal progesterone remained dominant in all cervical length ranges with lower costs and fewer PTBs (15-19mm $13,846 vs. $20,660, 20-24mm $10,063 vs. $14,209, 2529mm $7,702 vs. $10,183). Correspondingly, with the reduction in PTB, rates of cerebral palsy and neonatal death were decreased in the treatment arm. CONCLUSION: Vaginal progesterone is an effective and relatively noninvasive treatment strategy for women with CL measurements of 10-30mm. Outcomes of teenage pregnancies: all deliveries

Strip of the Month: August 2012

Strip of the Month: August 2012

The Association of Histologic Placental Inflammation with Category II Fetal Heart Tracings

The present study assessed whether placentas in women delivered by cesarean for category II fetal heart tracings (FHT) exhibit a higher incidence of acute inflammation than those of women delivered by cesarean for labor arrest. This case control study included singleton pregnancies ≥36 weeks of gestation delivered by cesarean for an FHT indication (cases) or because of labor arrest (controls) 2005-2009 at Prentice Women's Hospital. Exclusions were maternal diabetes, hypertension, known thrombophilia, connective tissue disorders, clinical evidence of chorioamnionitis, placental abruption, fetal anomalies, stillbirth, or an infant with a birth weight less than the 10th percentile. Women were included in the case group if the indication for cesarean delivery was based on the FHT and review of the FHT determined that they were designated as category II prior to delivery. A perinatal pathologist, unaware of indications for delivery, assessed placental inflammation in maternal and fetal compartments. Stage and grade of acute inflammation, from none to severe (scored 0-3), in the membranes, chorionic plate, chorionic vessels, and umbilical cord were assessed, and overall maternal and fetal inflammatory stages were assigned. Findings indicative of chronic inflammation were also noted. Other than lower umbilical artery cord gases in women with category II FHT, cases (n = 51) and controls (n = 27) had similar baseline characteristics and newborn outcomes, as well as similar placental pathologic findings. In uncomplicated patients, the presence or extent of placental inflammation does not appear to differ between women delivered for category II FHT and labor arrest.

Strip of the Month: February 2011

Strip of the Month: February 2011

163: Electronic fetal monitoring (EFM) patterns in the second stage of labor: association and test characteristics for fetal acidemia

in the second stage of labor: association and test characteristics for fetal acidemia Alison G. Cahill, Anthony Odibo, Kimberly Roehl, George Macones Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO OBJECTIVE: To estimate the association and screening efficacy of EFM patterns prior to delivery and acidemia using NICHD Categories and definitions. STUDY DESIGN: We conducted a 5-year retrospective cohort study of all singleton, non-anomalous gestations delivered at 37 weeks from the second stage of labor. The primary exposure was 30 minutes of EFM immediately prior to delivery, interpreted by 2 dedicated obstetric research nurses, formally trained and re-trained in EFM interpretation, blind to clinical and outcome data. EFM patterns were interpreted using the NICHD nomenclature, including the 3-Category system and feature definitions. EFM was interpreted in 10-minute epochs, and then overall. The primary outcome was acidemia, defined as an umbilical cord gas pH 7.10. Relative risks and 95% confidence intervals, and test characteristics for acidemia were calculated. RESULTS: Of 5,388 patients meeting inclusion criteria, 98.9% (5331) had a pH 7.10 and 1.1% (57) were acidemic. In bivariate analyses of the EFM patterns 30 minutes prior to delivery, baseline tachycardia (RR 3.3, 1.7 6.3) was the only pattern among NICHD-defined EFM Categories or features associated with acidemia; Categories IIII, minimal variability (RR 0.7, 0.3–1.6), marked variability (RR 2.2, 1.0 4.6), repetitive late (RR 1.3, 0.5–3.4) and prolonged decelerations (RR 3.1, 1.2– 8.2) all demonstrated no association. Test characteristics for each EFM Category or features were equally poor (Table). CONCLUSION: The NICHD 3-tiered Category system, as well as specifically defined features such as variability and deceleration types, demonstrate weak or no association with acidemia and do not demonstrate clinically useful test properties for EFM interpretation in the second stage. 164 Glial fibrillary acidic protein as a serum biomarker for the early identification of neonatal periventricular white matter injury in preterm neonates Amanda Stewart, Jacky Jennings, Aylin Tekes, Huisman Thierry, Frances Northington, William Savage, Allen Everett, Ernest Graham Johns Hopkins University School of Medicine, Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Baltimore, MD, John Hopkins University School of Medicine, Pediatrics, Baltimore, MD, Johns Hopkins University School of Medicine, Pediatric Neuro-Radiology, Baltimore, MD, Johns Hopkins University School of Medicine, Pediatrics, Baltimore, MD, Johns Hopkins University School of Medicine, Pathology-Transfusion Medicine, Baltimore, MD, Johns Hopkins University School of Medicine, Pediatric Cardiology, Baltimore, MD OBJECTIVE: Periventricular white matter injury(PWMI) in preterm infants results in cerebral palsy in 60-100% of survivors. Glial fibrillary acidic protein(GFAP), an abundant white matter protein localized to astrocytes, is normally undetectable in serum and only measureable after CNS injury. We sought to determine if serum GFAP levels can be used to identify neonates developing PWMI. STUDY DESIGN: This is a case control study of all neonates born at a single tertiary care hospital from 4/09 4/11 at 2334 weeks gestation diagnosed with PWMI on a head ultrasound at 6 weeks of life. Each case with PWMI was gestational age matched to a subsequent neonate with a normal head ultrasound. GFAP was measured in cord blood at the time of birth, at NICU admission, and on days 1-4 of life. Paired variables were compared using paired t-tests and McNemar chi square. Wilcoxon rank sum tests were used to compare GFAP levels. RESULTS: During this 2 year period, 21 cases with PWMI occurred. Cases and controls did not differ in birthweight (1077 / 544 grams, 963 / 492 grams) or incidence of cesarean delivery (61.9%, 66.7%). Cases with PWMI had a significantly increased incidence of intraventricular hemorrhage (90.5%, 23.8%, p 0.001), 5 min Apgar 7 (66.7%, 23.8%, p 0.01) and seizures (42.9%, 0%, p 0.004). There was no significant difference in umbilical arterial pH (7.22 /1 0.19, 7.27 / 0.06), or base deficit (4.4 / 6.8, 2.6 / 1.7). GFAP was not significantly different in cord blood, at NICU admission, or day 1, but was significantly increased at days 2-4 of life (p 0.002, 0.0005, 0.04). The 6 cases with cystic PWMI had significantly elevated GFAP levels compared to other cases (p 0.03). Logistic regression of GFAP at day 4 of life showed sensitivity 50%, specificity 78.6%, PPV 75% and NPV 55% in identifying PWMI. CONCLUSION: Serum GFAP levels were significantly elevated on day of life 2-4 in neonates diagnosed with PWMI at 6 weeks. Measurement of GFAP in the perinatal period provides a rapid quantitative way to diagnose white matter injury, and may also correlate with the scale of injury and neurocognitive outcomes. Poster Session I Clinical Obstetrics, Medical-Surgical-Disease, Neonatology, Physiology-Endocrinology www.AJOG.org

Strip of the Month: October 2011

Electronic fetal monitoring (EFM) is a popular technology used to establish fetal well-being. Despite its widespread use, terminology used to describe patterns seen on the monitor has not been consistent until recently. In 1997, the National Institute of Child Health and Human Development (NICHD) Research Planning Workshop published guidelines for interpretation of fetal tracings. This publication was the culmination of 2 years of work by a panel of experts in the field of fetal monitoring and was endorsed in 2005 by both the American College of Obstetricians and Gynecologists (ACOG) and the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). In 2008, ACOG, NICHD, and the Society for Maternal-Fetal Medicine reviewed and updated the definitions for fetal heart rate patterns, interpretation ,and research recommendations. Following is a summary of the terminology definitions and assumptions found in the 2008 NICHD workshop report. Normal values for arterial umbilical cord gas values and indications of acidosis are defined in Table 1.A three-tier Fetal Heart Rate Interpretation system has been recommended as follows: Data from Macones GA, Hankins GDV, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring. Obstet Gynecocol. 2008;112:661–666 and American College of Obstetricians and Gynecologists. Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. ACOG Practice Bulletin No. 106. Washington, DC: American College of Obstetricians and Gynecologists; 2009.We encourage readers to examine each strip in the case presentation and make a personal interpretation of the findings before advancing to the expert interpretation provided.A 28-year-old G2P1 woman at 38–3/7 weeks' gestation presents to labor and delivery in early labor desiring a trial of labor after cesarean section (TOLAC). She is currently contracting every 6 minutes, with intact membranes, and is admitted for augmentation of labor. She reports positive fetal movement and denies bleeding or leaking of fluid. Her history includes gestational diabetes (controlled by diet), a previous cesarean section for arrest of dilation at 3 cm, and a large-for-gestational age baby weighing 9 lb 8 oz. Her temperature is 36.8°C, heart rate is 78 beats/min, respiratory rate is 18 breaths/min, and blood pressure is 95/60 mm Hg. A cervical examination is deferred at this time. An initial FHR tracing is obtained shortly after admission (Fig. 1).Findings on EFM Strip #1 are: Over the next few hours, the patient receives early epidural analgesia and oxytocin therapy, and her contractions increase in intensity and frequency to every 2 minutes. Vital signs remain within normal limits, and she is afebrile. A cervical examination reveals 1 cm dilation, 70% effacement, and −2 station. Membranes are intact and oxytocin infusion is now at 10 MU/min. The FHR tracing remains a Category I, indicating a normal acid-base and a well-oxygenated fetus at this time. Four hours later, cervical examination shows 5 cm dilation, 80% effacement, and a floating station. A fetal tracing is obtained (Fig. 2).Findings on EFM Strip #2 are: Two hours later, results of a cervical examination document no changes, with 5 cm dilation and 80% effacement, but the station is now −2, allowing artificial rupture of the membranes. Clear fluid is noted. A fetal scalp electrode (FSE) and intrauterine pressure catheter (IUPC) are inserted to assess FHR variability more accurately and quantify uterine activity and intrauterine pressure. The associated tracing is seen in Figure 3.Findings on EFM Strip #3 are: Over the next hour, the FHR tracing remains a Category I, with recurrent early decelerations. Contractions continue every 2 minutes, with 180 MVUs. Maternal vital signs are within normal limits. The plan is to continue to monitor FHR and uterine activity and recheck the cervix in 2 hours to rule out an arrest of dilatation. However, the findings on the FHR tracing obtained 1 hour later (Fig. 4) prompt a change in plans.Findings on EFM Strip #4 are: Approximately 9 minutes later, a viable female infant weighing 3,620 kg is delivered by cesarean section with Apgar scores of 8 and 8 at 1 and 5 minutes, respectively. Cord gases indicate a mild respiratory acidosis (Table 2). Even though there was no evidence of a uterine rupture, the decision to deliver immediately was a good one and reflects a very efficient team that was well prepared to expedite the delivery of the infant within minutes of the prolonged deceleration.

Interpretation of umbilical cord gas results in cases of shoulder dystocia

Interpretation of umbilical cord gas results in cases of shoulder dystocia

Interpretation of umbilical cord gas results in cases of shoulder dystocia

Interpretation of umbilical cord gas results in cases of shoulder dystocia

Strip of the Month: August 2011

Strip of the Month: August 2011

Strip of the Month: May 2011

Strip of the Month: May 2011