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

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.

Decision to Incision and Risk for Fetal Acidemia, Low Apgar Scores, and Hypoxic Ischemic Encephalopathy

Objective This study aimed to assess risk for fetal acidemia, low Apgar scores, and hypoxic ischemic encephalopathy based on decision-to-incision time interval in the setting of emergency cesarean delivery. Study Design This unplanned secondary analysis of the Maternal–Fetal Medicine Units prospective observational cesarean registry dataset evaluated risk for hypoxic ischemic encephalopathy, umbilical cord pH ≤7.0, and Apgar score ≤4 at 5 minutes based on decision-to-incision time for emergency cesarean deliveries. Cesarean occurring for nonreassuring fetal heart rate monitoring, bleeding previa, nonreassuring antepartum testing, placental abruption, or cord prolapse was classified as emergent. Decision-to-incision time was categorized as <10 minutes, 10 to <20 minutes, 20 to <30 minutes, 30 to <50 minutes, or ≥50 minutes. As secondary outcomes umbilical cord pH ≤7.1, umbilical artery pH ≤7.0, and Apgar score ≤5 at 5 minutes were analyzed. Results Of 5,784 women included in the primary analysis, 12.4% had a decision-to-incision interval ≤10 minutes, 20.2% 11 to 20 minutes, 14.9% 21 to 30 minutes, 18.2% 31 to 50 minutes, and 16.5% >50 minutes. Risk for umbilical cord pH ≤7.0 was highest at ≤10 and 11 to 20 minutes (10.2 and 7.9%, respectively), and lowest at 21 to 30 minutes (3.9%), 31 to 50 minutes (3.9%), and >50 minutes (3.5%) (p < 0.01). Risk for Apgar scores ≤4 at 5 minutes was also higher with decision-to-incision intervals ≤10 and 11 to 20 minutes (4.3 and 4.4%, respectively) compared with intervals of 21 to 30 minutes (1.7%), 31 to 50 minutes (2.1%), and >50 minutes (2.0%) (p < 0.01). Hypoxic ischemic encephalopathy occurred in 1.5 and 1.0% of women with decision-to-incision intervals of ≤10 and 11 to 20 minutes compared with 0.3 and 0.5% for women with decision-to-incision intervals of 21 to 30 minutes and 31 to 50 minutes (p = 0.04). Risk for secondary outcomes was also higher with shorter decision-to-incision intervals. Conclusion Shorter decision-to-incision times were associated with increased risk for adverse outcomes in the setting of emergency cesarean. Key Points

Apgar Score and Umbilical Cord pH as Prognostic Predictors in Very Low Birth Weight Premature Neonates

Objective To estimate the reliability of the Apgar score (AS) and umbilical cord pH (UCP) as prognostic tools among very low birth weight (VLBW) infants. Study Design Retrospective study based on data of 1237 VLBW neonates born between 1997 and 2013 at one tertiary medical center. For each newborn, a complication score (CS) was calculated based on common complications of prematurity. Results The AS at 1 and 5 minutes correlated well with CS (correlation coefficients -0.47 and -0.52, respectively). No significant correlation was found between UCP and CS (correlation coefficient -0.08). Multi regression analysis revealed that the variables with the greatest prognostic contribution were birth weight, gestational age and prenatal steroid administration (beta values 0.277, 0.251 and 0.087, respectively). Conclusion The AS at 1 and 5 minutes, but not UCP, combined with gestational age, birth weight, and prenatal steroids, can be significant parameters for predicting prognosis among VLBW neonates.

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

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.

Birth plan compliance and its relation to maternal and neonatal outcomes

ABSTRACT Objective: to know the degree of fulfillment of the requests that women reflect in their birth plans and to determine their influence on the main obstetric and neonatal outcomes. Method: retrospective, descriptive and analytical study with 178 women with birth plans in third-level hospital. Inclusion criteria: low risk gestation, cephalic presentation, single childbirth, delivered at term. Scheduled and urgent cesareans without labor were excluded. A descriptive and inferential analysis of the variables was performed. Results: the birth plan was mostly fulfilled in only 37% of the women. The group of women whose compliance was low (less than or equal to 50%) had a cesarean section rate of 18.8% and their children had worse outcomes in the Apgar test and umbilical cord pH; while in women with high compliance (75% or more), the percentage of cesareans fell to 6.1% and their children had better outcomes. Conclusion: birth plans have a low degree of compliance. The higher the compliance, the better is the maternal and neonatal outcomes. The birth plan can be an effective tool to achieve better outcomes for the mother and her child. Measures are needed to improve its compliance.