DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20160141

Relationship between immediate postpartum umbilical cord blood pH and fetal distress

Naina Kumar, Aakanksha Suman, Krutika Sawant

Abstract


Background: Umbilical cord pH is best indicator of fetal hypoxemia. Objectives: To establish relation between cord blood pH and fetal distress, diagnose true fetal distress retrospectively, reduce caesarean section rates.

Methods: Prospective study of 30 term women reporting to labour room of department of Obstetrics Gynecology of a rural tertiary care centre of Central India with complaints of labour pains and during labour who developed fetal distress was conducted between April - May 2015. Immediately after delivery, umbilical cord arterial blood sample was collected. Maternal demographic profile, neonatal outcomes in terms of APGAR score, cord pH, immediate ventilation, NICU admissions were recorded. The correlation between non-reassuring fetal hearts, meconium stained liquor and neonatal outcome was analyzed using SPSS version 20.

Results: Of 30 cases, 2 (6.67%) women had fetal bradycardia, 13 (43.34%) abnormal non-stress test, 5 (16.67%) meconium stained liquor and 10 (33.34%) fetal bradycardia/tachycardia with meconium stained liquor. Of all delivered babies, 10 (33.34%) had acidosis, with one having severe hypoxemia and acidosis (pH 6.85). Of these, 7 (70%) required NICU admission, one intubated for severe birth asphyxia. Rest 23 (76.67%) were born healthy, cared by mother. Of 13 women having abnormal NST, 10 (76.92%) underwent emergency cesarean section, 3 (23.07%) delivered vaginally. Of these, only 3 (23.07%) babies had acidosis and required NICU admission. All mothers were discharged with their babies healthy.

Conclusions: Neither Non-reassuring fetal heart rate, nor thin meconium stained liquor correlate with adverse neonatal outcome. Furthermore NST resulted in unnecessary increased cesarean sections.


Keywords


Acidosis, Asphyxia, Cesarean section, Meconium

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References


Rotich SK, Ndavi MP, Rukaria-Kaumbutho R, Kigondus CS. Early perinatal outcome in cases delivered through Caesarian section following clinical diagnosis of severe foetal distress at Kenyatta National Hospital. East Afr Med J. 2006;83(5):250-8.

Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2006;(19)3:CD006066.

Nielson JP, Grant AM. The randomized trails of intrapartum electronic fetal monitoring. In Spencer JA, Ward RH, eds. Intrapartum fetal surveillance. London; RCOG Press, 1993.

Wareham V, Bain C, Cruickshank D. Caesarean section audit by peer review. Eur J Obstet Gynecol Rep Biol. 1993;48:9-14.

Dellinger EH, Boehm FH, Crane MM. Electronic fetal heart rate monitoring: Early neonatal outcomes associated with normal rate, fetal stress, and fetal distress. Am J Obstet Gynecol. 2000;182:214-20.

Shiono PH, McNellis D, Rhoads GG. Reasons for the rising cesarean delivery rates: 1978-1984. Obstet Gynecol. 1987;69:696-700.

Tayade S. The Significance of Meconium Stained Amniotic Fluid – A Cross Sectional Study In A Rural Setup. IJBAR. 2012;12(3):861-66.

Berkus MD, Langer O, Samueloff A, Xenakis EM, Field NT, Ridgway LE. Meconium-stained amniotic fluid: increased risk for adverse neonatal outcome. Obstet Gynecol. 1994;84(1):115-20.

Parveen S. Umbilical cord arterial blood base excess as gold standard for foetal wellbeing screening test validity at term delivery. J Pak Med Assoc. 2010;60(5):347-50.

Riley RJ, Johnson JW. Collecting and analyzing cord blood gases. Clinical obstetrics and gynecology. 1993;36(1):13-23.

Vandenbussche FP, Oepkes D, Keirse MJ. The merit of routine cord blood pH measurement at birth. Journal of perinatal medicine. 1999; 27(3):158-65.

Borruto F, Comparetto C, Wegher E, Treisser A. Screening of foetal distress by assessment of umbilical cord lactate. Clin Exp Obstet Gynecol. 2006;33(4):219-22.

Executive Committee of the Society of Obstetricians and Gynecologists of Canada. Attendance at labour and delivery: guidelines for obstetrical care. SOGC Policy Statement No. 89, May 2000. J Soc Obstet Gynaecol Can. 2000;22:389–91. Accessed online from 2007.

Ahmadpour-Kacho M, Asnafi N, Javadian M, Hajiahmadi M, Taleghani N. Correlation between Umbilical Cord pH and Apgar Score in High-Risk Pregnancy. Iran J Pediatr. 2010;20(4):401-6.

Ghosh B, Mittal S, Kumar S, Dadhwal V. Prediction of perinatal aspHyxia with nucleated red blood cells in cord blood of newborns. Int J Gynaecol Obstet. 2003;81(3):267-71.

The report of ACOG’s task force on neonatal encephalopathy and cerebral palsy has been published.

Tong S, Egan V, Griffin J, Wallace EM. Cord blood sampling at delivery: do we need to always collect from both vessels? BJOG. 2002;109(10):1175-7.

Goldaber KG, Gilstrap LC 3rd, Leveno KJ, Dax JS, McIntire DD. Pathologic fetal acidemia. Obstet Gynecol. 1991;78(6):1103-7.

Williams KP, Singh A. The correlation of seizures in newborn infants with significant acidosis at birth with umbilical artery cord gas values. Obstet Gynecol. 2002;100(3):557-60.

Goodwin TM, Belai I, Hernandez P, Durand M, Paul RH. AspHyxial complications in the term newborn with severe umbilical acidemia. Am J Obstet Gynecol. 1992;167(6):1506-12.

Low JA, Galbraith RS, Muir DW, Killen HL, Pater EA, Karchmar EJ. Motor and cognitive deficits after intrapartum aspHyxia in the mature fetus. Am J Obstet Gynecol. 1988;158(2):356-61.

Sehdev HM, Stamilio DM, Macones GA, Graham E, Morgan MA. Predictive factors for neonatal morbidity in neonates with an umbilical arterial cord pH less than7.00. Am J Obstet Gynecol. 1997;177(5):1030-4.

Blickstein I, Green T. Umbilical cord blood gases. Clin Perinatol. 2007;34(3):451-9.

Modarressnejad V. Umbilical cord blood pH and risk factors for acidaemia in neonates in Kerman. East Mediterr Health J. 2005;11(1-2):96-101.

Yeomans ER, Gilstrap LC 3rd, Leveno KJ, Burris JS. Meconium in the amniotic fluid and fetal acid-base status. Obstet Gynecol. 1989;73(2):175-8.

Ramin SM, Gilstrap LC, Leveno KJ, Burris J, Dax JS, Little BB. Acid–base significance of meconium discovered prior to labor. American journal of perinatology. 1993;10(2):143-5.

Wilkinson C, McIlwaine G, Boulton-Jones C, Cole S. Is arising caesarean section rate inevitable? Br J Obstet Gynaecol.1998;105:45-52.

Okunwobi-Smith Y, Cooke I, MacKenzie IZ. Decision to delivery intervals for assisted vaginal vertex delivery. Br J Obstet Gynaecol. 2000;107:467-71.

Grivell RM, Alfirevic Z, Gyte GM, Devane D. Antenatal cardiotocograpHy for fetal assessment. Cochrane Database Syst Rev. 2012;12:CD007863.

Nelson KR, Dambrosia JM, Ting TY, Grether JK. Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med. 1996;334: 613-8.

Vintzileos AM, Nochimson DJ, Guzman ER, Knuppel RA, Lake M, Schifrin BS. Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: a meta-analysis. Obstet Gynecol. 1995;85(1):149-55.

McDonald D, Grant A, Sheridan-Pereira M, Boylan P, Chalmers I. The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring. Am J Obstet Gynecol. 1985;152:524-39.

Neilson JP. EFM + scalp sampling vs. intermittent auscultation in labour. In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, eds. Pregnancy and childbirth module. Cochrane database of systematic reviews: review no. 03297, 4 May 1994, “Cochrane Updates on Disk.” Oxford: Update Software, 1994, Disk Issue 1.

Childbirth Connection. (2012). Vaginal or Cesarean Birth: What Is at Stake for Women and Babies? New York.

Goer H, Amy R. Optimal Care in Childbirth: The Case for a PHysiologic Approach. Seattle: Classic Day Publishing.2012.

Vintzileos AM, Nochimson DJ, Guzman ER, Knuppel RA, Lake M, Schifrin BS. Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: a meta-analysis. Obstet Gynecol. 1995;85(1):149-55.

Kelso IM, Parsons RJ, Lawrence GF, Arora SS, Edmonds DK, Cooke ID. An assessment of continuous fetal heart rate monitoring in labor. A randomized trial. Am J Obstet Gynecol. 1978;131(5):526-32.

Wood C, Renou P, Oats J, Farrell E, Beischer N, Anderson I. A controlled trial of fetal heart rate monitoring in a low-risk obstetric population. Am J Obstet Gynecol. 1981;141(5):527-34.

Kaban A, Cengiz H, Kaban I, Özcan A, Karakaş S. The success of cardiotocograpHy in predicting perinatal outcome. J Clin Exp Invest. 2012;3(2):168-71.