Placental abruption and neonatal anemia

Tweddell, Sarah M.; Bahr, Timothy M.; Henry, Erick; Pagé, Jessica; Ilstrup, Sarah J.; Ohls, Robin K.; Christensen, Robert D.

doi:10.1038/s41372-023-01603-w

Cited by 1 publication

(1 citation statement)

References 15 publications

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“…In 275 of the 500 confirmed abruption cases (55%) we found no indication of the abruption size, moreover the recorded abruption sizes were inconsistent and vague, making stratification of pH values according to abruption size impossible. 10 Including a hemoglobin level with the umbilical cord blood gas proved to be a meaningful addition. As shown in Figure 1, among the 707 that had a cord hemoglobin reported, fetal/neonatal anemia was diagnosed in 83 (12%) (defined as a hemoglobin below the fifth percentile lower reference interval for gestational age), and severe anemia (defined as below the first percentile) was diagnosed in 16 (2%).…”

Section: Resultsmentioning

confidence: 99%

Evaluating Practice Consistency: Complying with the Directive to Obtain Umbilical Cord Arterial and Venous Blood Gasses, and Hemoglobin Values, at High-risk Deliveries

Christensen,

Bahr,

Tweddell

et al. 2024

Newborn

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Introduction:Using Intermountain Health multihospital data, we quantified compliance with the American College of Obstetricians and Gynecologists directive to obtain umbilical cord arterial and venous blood gasses at high-risk deliveries. We also quantified compliance with our local directive to obtain hemoglobin with the cord gasses as an early screen for anemia. Methods: Retrospective 24-month analysis of Intermountain Health deliveries. Results: One-thousand-fifty births had "placental abruption" mentioned in the peripartum notes. These constituted our high-risk delivery study cohort. Of these, 726 (69%) had both a cord arterial and venous sample reported; 707 (67%) also had hemoglobin reported. In 86 (8%) only one (arterial or venous) was reported, and 293 (23%) had neither gasses nor hemoglobin. One-hundred-seven of the 726 had acidosis (cord arterial pH <7.13) and 619 did not (pH ≥7.13). Among those with acidosis, 82 had abruption confirmed after birth; in 25 abruption was not confirmed. Paired umbilical arterial vs venous hemoglobin levels revealed the novel observation that umbilical venous hemoglobin is slightly lower than arterial (p < 0.0001), perhaps due to maternal-to-fetal acellular fluid transfer. Among the 707 that had cord hemoglobin reported, fetal/neonatal anemia was diagnosed in 83 (12%) (defined as hemoglobin below the fifth percentile lower reference interval for gestational age). Conclusions: We see an opportunity to improve compliance with the directives to obtain cord arterial and venous blood gas and hemoglobin at high-risk births. Doing so will allow rapid evaluation of about 30% more high-risk infants for the presence of acidosis and anemia at birth.

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Section: Resultsmentioning

confidence: 99%