Is pulsating cord blood sampling a suitable and reliable method for cord gas analysis at birth?

Tommaso, Mariarosaria Di; Vannuccini, Silvia

doi:10.1111/aogs.13434

Cited by 2 publications

(2 citation statements)

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“…We thank Prof. Di Tommaso and Vannuccini for their interest in our article . We congratulate their group for the study “ Blood gas values in clamped and unclamped umbilical cord at birth” .…”

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confidence: 94%

Timing of cord clamping for blood gas analysis is of paramount importance

Xodo

Berghella

2018

Acta Obstet Gynecol Scand

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Timing of cord clamping for blood gas analysis is of paramount importanceSir,We thank Prof. Di Tommaso and Vannuccini for their interest in our article. 1,2 We congratulate their group for the study "Blood gas values in clamped and unclamped umbilical cord at birth". 3 In their prospective observational study, published in 2014, 46 patients delivered vaginally at term; for each patient, cord blood gas analysis was performed after blood collection had been carried out in two different ways. The first two blood samples, arterial and venous, were obtained from the unclamped cord within 90 seconds from birth.After that, two other samples were taken from a 10-cm segment of a double-clamped cord. No significant differences were observed on arterial pH, pO 2 , pCO 2 , SaO 2 or hemoglobin concentration (ctHb) between the samples obtained within 90 seconds from birth and the clamped samples analyzed immediately after the previous sampling.In contrast, the venous SaO 2 , ctHb and BE turned out to be significantly different between the unclamped and clamped cord, although pH, pO 2 and pCO 2 were comparable.We apologize for not having cited their study, 3 which actually reinforces our hypothesis with experimental data. Di Tommaso et al demonstrate a statistically significant difference between the arterial BE by comparing the two methods. 3 The same trend toward a higher (ie, less negative) BE in the unclamped samples is present in the venous cohort. There may be a slight variation in the interpretation of these data. While Di Tommaso et al give main importance to the difference between the two techniques of umbilical cord blood collection, we instead give priority to the difference in timing of blood collection. In our opinion, timing is a crucial issue, especially in newborns at risk of intrapartum asphyxia. Timing of blood collection explains why the median BE level is higher in unclamped samples than in clamped ones. Since the blood collection in unclamped cords was performed within 90 seconds after birth, the BE correlates more closely with the intrapartum cord gas status. After this lapse of time, two variables may influence the efficacy of the cord blood gases: sampling after the onset of newborn's breathing 4 or sampling after a condition of hidden acidosis has been established in the newborn. 5Obviously, these slight changes in cord blood gases at birth may have a higher impact in those fetuses who suffered from a hypoxic stress during labor. We once again congratulate Di Tommaso et al on their important work, 3 and for the opportunity to even better delineate our clinical correlations.We therefore suggest performing cord blood sampling for gas analysis as soon as possible after birth. Further experimental studies are needed to establish the exact timing, and to evaluate whether best timing is even before onset of breathing. Surely, the technique of blood collection from the intact (unclamped) and still pulsating umbilical cord is a suitable method in clinical practice. 1. Di Tommaso M, Vannuccini S. Is pulsating co...

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confidence: 94%

Timing of cord clamping for blood gas analysis is of paramount importance

Xodo

Berghella

2018

Acta Obstet Gynecol Scand

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“…After the introduction of DCC, CBG sampling from the unclamped cord has been implemented; this technique has been demonstrated to provide similar results compared with the standard procedure, and allows cord blood sampling within seconds after birth without interfering with postnatal adaptation.…”

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confidence: 99%

The effect of delayed umbilical cord clamping on cord blood gas analysis in vaginal and caesarean‐delivered term newborns without fetal distress: a prospective observational study

Giovannini

Crippa

Denaro

et al. 2019

BJOG

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Objective To determine variations in cord blood gas (CBG) parameters after 3-minute delayed cord clamping (DCC) in vaginal deliveries (VDs) and caesarean deliveries (CDs) at term without fetal distress.Design Prospective observational study. Setting University hospital.Sample CBG from 97 VDs and 124 CDs without fetal distress.Methods Comparison of paired arterial-venous CBG parameters drawn at birth from the unclamped cord and after 3-minutes DCC for VDs and CDs.Main outcome measures Base excess, bicarbonate, haematocrit and haemoglobin from both arterial and venous cord blood, lactate, neonatal outcomes, partial pressure of oxygen (pO 2 ), partial pressure of carbon dioxide (pCO 2 ), pH, and postpartum haemorrhage.Results Arterial cord blood pH, bicarbonate (HCO À 3 , mmol/l), and base excess (BE, mmol/l) decreased significantly after 3minute DCC both in VDs (pH = 7.23 versus 7.27; P < 0.001; HCO À 3 = 23.3 versus 24.3; P = 0.004; BE = À5.1 versus À2.9; P < 0.001) and CDs (pH = 7.28 versus 7.34; P < 0.001; HCO À 3 = 26.2 versus 27.2; P < 0.001; BE = À1.5 versus 0.7; P < 0.001). After 3-minute DCC, pCO 2 increased in CDs only (57 versus 51; P < 0.001), whereas lactate increased more in CDs compared with VDs (lactate, +1.1 [0.9, 1.45] versus +0.5 [À0.65, 2.35]; P = 0.01). Postpartum maternal haemorrhage, neonatal maximum bilirubin concentration, and need for phototherapy were similar between the two groups. Newborns born by CD more frequently required postnatal clinical monitoring or admission to a neonatal intensive care unit.Conclusions After 3-minute DCC, the acid-base status shifted towards mixed acidosis in CDs and prevalent metabolic acidosis in VDs. CDs were associated with a more pronounced increase in arterial lactate, compared with VDs.Tweetable abstract By 3-minute DCC, acid-base status shifts towards mixed and metabolic acidosis in caesarean and vaginal delivery, respectively. The effect of delayed umbilical cord clamping on cord blood gas analysis in vaginal and caesarean-delivered term newborns without fetal distress: a prospective observational study. BJOG 2020;127:405-413.

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Is pulsating cord blood sampling a suitable and reliable method for cord gas analysis at birth?

Cited by 2 publications

References 5 publications

Timing of cord clamping for blood gas analysis is of paramount importance

Timing of cord clamping for blood gas analysis is of paramount importance

The effect of delayed umbilical cord clamping on cord blood gas analysis in vaginal and caesarean‐delivered term newborns without fetal distress: a prospective observational study

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