DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20200673

Base excess as a prognostic factor determining the perinatal outcome

Chandrakala P., Shilpa Deborah Lysander, Jayalalitha .

Abstract


Background: Umbilical cord blood gas assessment seems to be the most objective determination of fetal metabolic condition at the time of birth and can be used to assess the perinatal outcome of the baby. In the early stage of an impaired placental circulation, hypoxemia and hypercapnia result in a decrease in pH with BD maintained normal (respiratory acidemia), whereas if the hypoxic process develops into a sustained anaerobic metabolism the BD rises secondary to lactic acidosis and consumption of buffer.

Methods: Observational study done in KIMS hospital Bangalore, Karnataka, India, in a study period of 18 months on a sample size of 100. Within 30 sec of delivery a segment of umbilical cord was clamped at both ends. Cord blood was collected in heparinised syringe. It was then transported with cold ice packs and blood pH, pCO2, pO2 were measured.

Results: In present study, there was a significant difference between the 2 groups in terms of BE, BE being highest in the group without complication. There was a moderate negative correlation between duration of NICU stay (days) and BE (mmol/L), and this correlation was statistically significant. There was a significant difference between the 2 groups in terms of BE with the median BE (mmol/L) being highest in the group not requiring resuscitation. At a cutoff of BE (mmol/L) <-17.5, it predicts complications with a sensitivity of 71.4%, and a specificity of 88.2%.

Conclusions: Hence cord blood base excess can be used as a prognostic factor in determining the perinatal outcome.


Keywords


ABG, Base excess, Metabolic acidosis, Perinatal complications

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References


Knutzen L, Svirko E, Impey L. The significance of base deficit in acidemic term neonates. Am J Obstet Gynecol. 2015;213(3):373.e1-373.e7.

Wiberg N, Källén K, Olofsson P. Base deficit estimation in umbilical cord blood is influenced by gestational age, choice of fetal fluid compartment, and algorithm for calculation. Am J Obstet Gynecol. 2006;195(6):1651-6.

Mokarami P, Wiberg N, Olofsson P. An overlooked aspect on metabolic acidosis at birth: blood gas analyzers calculate base deficit differently. Acta Obstet Gynecol Scand. 2012;91(5):574-9.

Low JA. Intrapartum fetal asphyxia: definition, diagnosis, and classification. Am J Obstet Gynecol. 1997;176(5):957-9.

Hafstrom M, Ehnberg S, Blad S, Noren H, Renman C, Rosen KG, et al. Developmental outcome at 6.5 years after acidosis in term newborns: a population-based study. Pediatrics. 2012;129(6):e1501-7.

Utility of umbilical cord blood acid-base assessment. ACOG committee opinion: committee on obstetric practice. Number 138--April 1994. Int J Gynaecol Obstet. 1994;45(3):303-4.

Goldaber KG, Gilstrap LC. Correlations between obstetric clinical events and umbilical cord blood acid-base and blood gas values. Clin Obstet Gynecol. 1993;36(1):47-59.

Low JA. The role of blood gas and acid-base assessment in the diagnosis of intrapartum fetal asphyxia. Am J Obstet Gynecol. 1988;159(5):1235-40.

Hagelin A, Leyon J. The effect of labor on the acid-base status of the newborn. Acta Obstet Gynecol Scand. 1998;77(8):841-4.

Victory R, Penava D, Da Silva O, Natale R, Richardson B. Umbilical cord pH and base excess values in relation to adverse outcome events for infants delivering at term. Am J Obstet Gynecol. 2004;191(6):2021-8.

Wiberg N, Källén K, Herbst A, Olofsson P. Relation between umbilical cord blood pH, base deficit, lactate, 5-minute Apgar score and development of hypoxic ischemic encephalopathy. Acta Obstet Gynecol Scand. 2010;89(10):1263-9.