scholarly journals Determining an Umbilical Cord pH Cutoff Value for Predicting Neonatal Morbidity Related to Intrapartum Hypoxia

2019 ◽  
Vol 70 (2) ◽  
pp. 605-607
Author(s):  
Magdalena Mogos ◽  
Catalin Gabriel Herghelegiu ◽  
Raluca Gabriela Ioan ◽  
Cringu Antoniu Ionescu ◽  
Adrian Neacsu
Keyword(s):  
Umbilical Cord ◽  
Neonatal Outcome ◽  
Perinatal Asphyxia ◽  
Subjective Evaluation ◽  
Neonatal Morbidity ◽  
Youden Index ◽  
Control Group ◽  
Cutoff Value ◽  
Fetal Acidosis ◽  
Umbilical Cord Ph

Intrapartum hypoxia can lead to perinatal asphyxia, acidosis, neuronal injury, long-term morbidity or even death. Intrapartum asphyxia and hypoxia can be predicated by fetal acidosis. Umbilical cord gases are used to evaluate a newborn�s acid-base status and the presence of hypoxia. Depending on what references are used, normal values for umbilical cord gases can wildly vary. Although most papers set a pH threshold of [7.2 for fetal acidosis / acidemia, some studies suggest that neonatal morbidity and mortality is increased only when the pH threshold is set below / cut-off value is 7.0. We did a retrospective study and evaluated all newborns from singleton term births in INSMC Alessandrescu Rusescu between 2010 - 2012. We found 83 cases of intrapartum asphyxia (IA) and 25 cases of hypoxic ischemic encephalopathy (HIE). Also a control group of 100 normal term newborns were randomly selected. The IA and HIE showed significant lower mean umbilical cord pH values compared to the control group (7.19, respectively 7.12 compared to 7.28). Using the Youden index we calculated pH a cutoff value of 7.25 for the prediction of IA and of 7.16 for the prediction of HIE. While a low Apgar score can be a predictor of neonatal outcome and may be determined by fetal hypoxia, it remains a subjective evaluation with variable intra-observer reliability. Thus it is important to have an objective test able to accurately diagnose perinatal asphyxia and predict the neonatal outcome.

scholarly journals A Study on Correlation of Umbilical Cord Arterial Blood pH with Perinatal Asphyxia & Early Neonatal Outcome

2020 ◽  
Vol 8 (2) ◽  
pp. 30-35
Author(s):  
Nutan Singh ◽  
Asheesh Kumar Gupta ◽  
Ajay Kumar Arya
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Neonatal Outcome ◽  
Outcome Measurement ◽  
Perinatal Asphyxia ◽  
Birth Asphyxia ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
Arterial Blood ◽  
Blood Ph

Background: Perinatal asphyxia is one of the major causes of neonatal morbidity & mortality. Asphyxia can damage almost every organ of neonate. Our purpose was to determine the correlation of cord blood pH with birth asphyxia & early neonatal outcome. Subjects and Methods: A prospective study was conducted over a period of one year at STH Haldwani. We enrolled 108 term neonates with signs of fetal distress, thick MSL, non-reassuring NST & there were subjected for estimation of umbilical cord blood pH, APGAR score, outcome looked were resuscitation needed, NICU admission, delay in feed & encephalopathy (sarnat & sarnat stage). Results: In our study, cord blood pH had significant correlation with perinatal asphyxia(R=-0.926). Area under ROC curved showed that mean pH <7.1 (ROC=0.998) is very significant in predicting the adverse outcome. Conclusion: Cord blood pH is very sensitive and specific & has good correlation in predicting the birth asphyxia & adverse neonatal outcome. Measurement of cord blood pH is recommended in all the neonates with signs of fetal distress.

scholarly journals Study of intrapartum fetal distress with the help of cardiotocography and its correlation with umbilical cord blood sampling

2020 ◽  
Vol 9 (4) ◽  
pp. 1580
Author(s):  
S. Neeraja ◽  
Sugathi Parimala ◽  
Naima Fathima
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
Risk Groups ◽  
Normal Vaginal Delivery ◽  
Arterial Blood ◽  
Blood Ph ◽  
Fetal Acidosis

Background: Even in low risk mothers, fetal acidosis occurs as in high risk groups. Aim of fetal monitoring is to detect early response to intrauterine hypoxia and prevent irreversible neurological damage and death. Objective of this study was to correlate the intrapartum fetal distress with the help of cardiotocography CTG with umbilical cord blood sampling.Methods: A total 100 consecutive patients attending the labor ward were studied. Immediately at birth, before the baby’s first breath and before delivery of the placenta, the umbilical cord blood was collected as per the standard guidelines laid down in the standard textbooks. Fetal acidosis was assessed by umbilical cord arterial blood pH. Fetal acidosis was considered when umbilical artery pH <7.2. Cardiotocography features were used to clinically diagnose fetal distress.Results: Most of the mothers were multigravida. They belonged to the age group of 20-25 years. Only 18% had abnormal CTG. Out of 50 mothers with normal vaginal delivery, all had normal CTG. Out of 43 mothers who were delivered by LSCS, no one had normal CTG, 25 had indeterminate CTG and 18 had abnormal CTG. As CTG became abnormal, proportion of mothers with the thick meconium increased. NICU admission proportion increased as CTG changed from normal to the abnormal. There was a significant association between the abnormal CTG and the umbilical cord blood pH being acidic.Conclusions: CTG is a simple test, easy to perform and can alert obstetrician for necessary interventions in case of an abnormal CTG. It can detect fetal distress in labor thus helping to reduce neonatal morbidity by early intervention in cases of abnormal tracing.

scholarly journals Prenatal sFlt-1/PlGF value for prediction of adverse neonatal outcome of isolated ultrasonic small-for-gestational-age fetus in normotensive pregnant women: A prospective cohort study

2019 ◽  
Author(s):  
So Hyun Shim ◽  
Haeng Jun Jeon ◽  
Hye Jin Ryu ◽  
So Hyun Kim ◽  
Seung Gi Min ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Neonatal Outcome ◽  
Adverse Outcome ◽  
Control Group ◽  
Third Trimester ◽  
Cutoff Value ◽  
Adverse Neonatal Outcome ◽  
Increased Risk ◽  
Plgf Ratio

Abstract Background: Not only preeclampsia but also small-for-gestational-age (SGA) neonates in the absence of preeclampsia are at increased risk of morbidity and mortality. Early recognition of fetuses at increased risk of being growth-restricted enables more appropriate surveillance and optimization of management for reduced risk of adverse neonatal outcomes. We investigated potential value of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio, estimated in late-second and early-third trimester respectively, for prediction of SGA neonates with poor neonatal outcome in the absence of preeclampsia. Methods: Included in this case control study were 530 singleton pregnant women who had attended the prenatal screening program at single institution between January 2011 and March 2012. Demographic and clinical information of maternal and neonatal data were collected. The sFlt-1/ PlGF value at 24 to 28+6 weeks and 29 to 36+6 weeks of gestation were analyzed for comparing appropriate for gestational age control group, SGA and SGA with poor neonatal group. Results: After excluding 22 preeclampsia cases, 47 SGA group and 461 control-group were included. Among SGA group, 17 neonates had adverse neonatal outcome (36.1%, 17/47). Mean gestational age at delivery in SGA group was 37.76±2.05 weeks, which showed no significant difference comparing to control group (38.43±2.1 weeks, p=0.122). The sFlt-1/PlGF ratios at late-second trimester were both higher in the SGA group and poor neonatal SGA group than control group (3.74±2.52 vs 6.73±8.22 vs 7.62±15.2, p=0.63) and especially sFlt-1/PlGF ratio at early-third trimester was significantly higher (14.41±12.5 vs 28.62±37.2 vs 109.12±83.96, p=0.002). As gestational age advances, rapid increase in sflt-1/PlGF ratio detected in poor SGA group comparing to SGA group with no adverse outcome. A cutoff value of 28.15 for the sFlt-1/PlGF ratio at 29 to 36+6weeks significantly predicted SGA neonates who had adverse outcome, with sensitivity and specificity of 76.9% and 88%, respectively. Conclusion: In this study, sFlt-1/PlGF ratio of SGA with adverse neonatal outcome group was significantly higher than control group. This study suggests the feasibility of the sFlt-1/PlGF ratio as helpful objective measurement for predicting the adverse SGA neonatal outcome by providing sFlt-1/PlGF cutoff value, besides ultrasound biometry measurement.

scholarly journals Prenatal sFlt-1/PlGF value for prediction of adverse neonatal outcome of isolated ultrasonic small-for-gestational-age fetus in normotensive pregnant women: A prospective cohort study

2019 ◽  
Author(s):  
So Hyun Shim ◽  
Haeng Jun Jeon ◽  
Hye Jin Ryu ◽  
So Hyun Kim ◽  
Seung Gi Min ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Neonatal Outcome ◽  
Adverse Outcome ◽  
Control Group ◽  
Third Trimester ◽  
Cutoff Value ◽  
Adverse Neonatal Outcome ◽  
Increased Risk ◽  
Plgf Ratio

Abstract Background Not only preeclampsia but also small-for-gestational-age (SGA) neonates in the absence of preeclampsia are at increased risk of morbidity and mortality. Early recognition of fetuses at increased risk of being growth-restricted enables more appropriate surveillance and optimization of management for reduced risk of adverse neonatal outcomes. We investigated potential value of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio, estimated in late-second and early-third trimester respectively, for prediction of SGA neonates with poor neonatal outcome. Methods Included in this case control study were 530 singleton pregnant women who had attended the prenatal screening program at single institution between January 2011 and March 2012. The maternal serum levels of sFlt-1 and PlGF at 24 to 28+6weeks and 29 to 36+6weeks of gestation were measured for comparing control and SGA group. Results After excluding 22 preeclampsia cases, 47 SGA group and 461 control-group were included. Mean gestational age at delivery in SGA group was 37.76 ± 2.05weeks, which showed no significant difference comparing to control group (38.43 ± 2.1weeks, p=0.122). The sFlt-1/PlGF ratios at late-second trimester and early-third trimester were both higher in the SGA group than control group (7.62 vs 3.74, p=0.63; 28.62 vs 14.42, p=0.037) and especially sFlt-1/PlGF ratio at early-third trimester was significantly higher in the SGA group. Among SGA group, 17 neonates had adverse neonatal outcome (36.1%, 17/47). Both sFlt-1/PlGF ratios in each trimester were also higher in poor SGA group than control group (6.73 vs 3.77, p = 0.379; 109.12 vs 15.27, p=0.002). As gestational age advances, rapid increase in sflt-1/PlGF ratio detected in poor SGA group comparing to SGA group with no adverse outcome. A cutoff value of 28.15 for the sFlt-1/PlGF ratio at 29 to 36+6weeks significantly predicted SGA neonates who had adverse outcome, with sensitivity and specificity of 76.9% and 88%, respectively. Conclusion In this study, sFlt-1/PlGF ratio of SGA with adverse neonatal outcome group was significantly higher than control group. This study suggests the feasibility of the sFlt-1/PlGF ratio as helpful objective measurement for predicting the adverse SGA neonatal outcome by providing sFlt-1/PlGF cutoff value, besides ultrasound biometry measurement.

scholarly journals Comparison of intravenous bolus doses of phenylephrine vs ephedrine along with crystalloid co-loading in the prevention of hypotension during spinal anesthesia for caesarean section

2021 ◽  
Vol 8 (4) ◽  
pp. 537-542
Author(s):  
Arunkumar Muthalu ◽  
Arthi Asokan ◽  
Vimala Ananthy ◽  
Shoba Ujjwal
Keyword(s):  
Caesarean Section ◽  
Umbilical Cord ◽  
Spinal Anaesthesia ◽  
Apgar Score ◽  
Caesarean Delivery ◽  
Neonatal Outcome ◽  
Study Groups ◽  
Common Side Effect ◽  
Normal Delivery ◽  
Fetal Acidosis

Caesarean section was the first obstetrical operation that saves the life of the baby when normal delivery fails. Spinal anaesthesia is the most appropriate method for caesarean section. But hypotension is the most common side effect of it in patient with pregnant uterus. To compare the vasopressor effects of ephedrine and phenylephrine in ameliorating hypotension in elective caesarean delivery receiving crystalloid coloading, during intrathecal bupivacaine injection.: Study participants were randomly divided into two groups of 50 patients each. After subarachnoid block, all the parturients were given rapid administration of ringer lactate solution 20ml/kg, during the initial 5 minutes of surgery the parameters such as oxygen saturation, blood pressure and pulse rate recorded for every one minute followed by every five minutes until the completion of the surgery. The incidence of hypotension, bradycardia, nausea/vomiting, block height and requirements of vasopressor (ephedrine and phenylephrine) were recorded. Apgar score, and blood sample from umbilical cord was taken and sent for blood gas analyses to determine the neonatal outcome.: Vasopressor consumption was more in phenylephrine group (92±112 µg) compared to ephedrine group (4.8±5.5 mg) which was statistically significant p=0.0001. The neonatal outcome was statistically significant regarding umbilical cord pH (Group E-7.2±0.06 and Group P-7.37±0.04 with p=0.002) but clinically no true fetal acidosis in either groups and no significant changes regarding Apgar score in the two groups.: Thus we conclude that that ephedrine 6 mg and phenylephrine 100 µg does not differ in their efficacy to manage hypotension during spinal anaesthesia for caesarean delivery. However, maternal bradycardia was more in the phenylephrine group with equal incidence of fetal acidosis in the study groups.

scholarly journals Relationship between immediate postpartum umbilical cord pH, fetal distress and neonatal outcome

2020 ◽  
Vol 36 (7) ◽  
Author(s):  
Wajeeha Syed ◽  
Nazia Liaqat ◽  
Qudsia Qazi ◽  
Sumaira Yasmin
Keyword(s):  
Birth Weight ◽  
Umbilical Cord ◽  
Apgar Score ◽  
Neonatal Outcome ◽  
Fetal Distress ◽  
P Value ◽  
Strong Positive Correlation ◽  
Strongly Correlated ◽  
Age Group ◽  
Umbilical Cord Ph

Objectives: To determine relationship between immediate postpartum umbilical cord pH, fetal distress and neonatal outcome Methods: This descriptive cross-sectional study was conducted in the department of Gynaecology, Lady Reading Hospital Peshawar, Pakistan, from January 2019 to July 2019. This study included 27 full-term pregnant women who had abnormal CTG during the active or latent phase of labour. Data were analyzed by IBM SPSS Statistics for Windows, Version 23.0. Results: Out of 27, most patients 13 (48.14%) were in the age group 20-25 years,11 (40.74%) to 26-30 years and 3 (11.11%) belonged to 31-35 years of age group. CTG abnormalities were severe bradycardia, late deccelerations and persistent variable deccelerations with loss of baseline variability. Of all delivered babies, 21 (77%) babies had birth weight<3.5 kg and 6 (22%) had >3.5 kg birth weight. 20 (74.07%) had acidosis (pH <7.2) at the time of birth, of which one had severe hypoxemia and acidosis with pH 6.85. APGAR score at 0 minutes showed a strong positive correlation (r=0.818, p= <0.001) with cord pH, while APGAR at five minutes was also strongly correlated (r= 773, p=<0.001). Of all babies 18(66.66%) with PH less than 7.2 were admitted in NICU while only 2 babies with PH more than 7.2 were admitted. (p value= 0.005). Conclusion: Low umbilical cord pH values of babies born by cesarean section (for fetal distress) are strongly correlated with low APGAR score at birth and higher rates of NICU admission. doi: https://doi.org/10.12669/pjms.36.7.2536 How to cite this:Syed W, Liaqat N, Qazi Q, Yasmeen S. Relationship between immediate postpartum umbilical cord pH, fetal distress and neonatal outcome. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.2536 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Umbilical cord pH and base excess values in relation to neonatal morbidity for infants delivered preterm

2003 ◽  
Vol 189 (3) ◽  
pp. 803-807 ◽  
Author(s):  
Rahi Victory ◽  
Deborah Penava ◽  
Orlando da Silva ◽  
Renato Natale ◽  
Bryan Richardson
Keyword(s):  
Umbilical Cord ◽  
Base Excess ◽  
Neonatal Morbidity ◽  
Umbilical Cord Ph

scholarly journals An observational study of early neonatal outcome in babies born to mothers with pregnancy induced hypertension

2020 ◽  
Vol 7 (8) ◽  
pp. 1781
Author(s):  
Ramya C. ◽  
Rathna Kumari ◽  
Charishma Chitneni
Keyword(s):  
Preterm Delivery ◽  
Neonatal Outcome ◽  
Mode Of Delivery ◽  
Neonatal Morbidity ◽  
Morbidity And Mortality ◽  
Control Group ◽  
P Value ◽  
Tertiary Center ◽  
Group A ◽  
Group B

Background: Hypertensive disorders in pregnancy are a major cause of maternal morbidity and mortality accounting for 15-20% of maternal deaths worldwide. In India the incidence of preeclampsia is reported to be 8-10 percent of the pregnancies objective of this study was to with the above background, this study was carried out to study early neonatal outcome in babies born to PIH mothers, Measure the adverse neonatal outcomes in the early neonatal period and compare the mode of delivery between control group and PIH group.Methods: A total of 58 neonates born to mothers diagnosed having gestational hypertension, preeclampsia, eclampsia were taken as tests (group A), and 100 apparently healthy newborns born to normotensive mothers were enrolled as controls (group B) and followed up to 1st week of life. The outcome measures were compared between groups in terms of mode of delivery, preterm delivery, birth weight, APGAR score, intra uterine growth retardation, early neonatal complications.Results: In group A, 33 had LBW (56.89%) and in group B 18 had LBW (18%). The incidence of preterm deliveries in group A was higher as compared to group B (A- 43.10%, B-17%, p value <0.05). Babies born to PIH mothers had an increased incidence of IUGR, as compared to group B.Conclusions: PIH is one of the major causes of maternal, fetal and early neonatal morbidity and mortality. In this study authors found that risk of LBW, preterm delivery, NICU admission and IUGR in babies born to PIH mothers statistically significant. Early detection of high-risk individual by well trained personnel and timely referral to advanced tertiary center is necessary in bringing down the maternal and neonatal morbidity and mortality.

scholarly journals Correlation between umbilical cord blood pH and meconium stained deliveries

2020 ◽  
Vol 7 (3) ◽  
pp. 670
Author(s):  
Shilpa Deborah Lysander ◽  
Chandrakala P. ◽  
Jayalalitha .
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Perinatal Asphyxia ◽  
Neonatal Morbidity ◽  
Developed Countries ◽  
Blood Ph ◽  
Significant Difference ◽  
Study Population ◽  
Acid Base Status

Background: Among all live births approximately 13% neonates are born through meconium-stained amniotic fluid and out of these 5-10% developed MAS, which increases neonatal morbidity and mortality. The incidence increases as the gestational age advances with reported frequencies at 37, 40, and >42 weeks being 3%, 13%, and 18% respectively. Although there is a significant decrease in the occurrence of MAS and associated mortality in developed countries, MAS remains a major problem in developing countries. The objective was to study the correlation between umbilical cord blood PH and Meconium stained amniotic fluid.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 population, among those with MSAF, 72% had acidemia and 28% did not have acidemia. The mean (SD) of pH in the group with MSAF was 7.16 (0.10). The median (IQR) of pH in the group with MSAF was 7.14 (0.12). There was no significant difference between the groups (those with MSAF and those without MSAF but other risk factors) in terms of pH (W = 867.500, p = 0.580).Conclusions: The presence of acidosis in the umbilical cord blood, used as a biochemical marker for perinatal asphyxia can be used to evaluate the significance of intrauterine passage of meconium. But a normal acid-base status at delivery present in many cases of MSAF, suggests that either a pre-existing injury or a non-hypoxic mechanism is often involved. MSAF is not always secondary to an acute hypoxic event.

Sign in / Sign up

Export Citation Format

Share Document