Study on umbilical cord arterial blood gas analysis and cord blood lactate levels as predictors for adverse neonatal outcome: an observational study

Patil, Suman Shivanagouda; Sukanya, .; Rath, Suman; George, Carolin Elizabeth

doi:10.18203/2320-1770.ijrcog20181342

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…35 Similar results were reported by another study which observed that cord blood lactate is better predictor of neonatal morbidity and mortality as compared to umbilical artery pH. 37 A recent study has also reported that elevated cord blood LDH levels were significantly associated with increased risk of neonatal mortality. 38 Another similar study found that both cord blood Lactate and pH values help in distinguishing between asphyxiated and non-asphyxiated neonates, but lactate levels were observed to be have a better discriminating power.…”

Section: Tablesupporting

confidence: 71%

Role of umbilical cord arterial pH and lactate in newborn assessment of term antenatal women with hypertensive disorders of pregnancy

Kumar

Yadav

2020

Clinical Epidemiology and Global Health

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To know role of cord arterial blood pH and lactate dehydrogenase levels in neonatal outcome assessment. Methods: Present observational study was conducted in Obstetrics and Gynecology department of a rural tertiary center of Northern India over 6 months (July-January 2019) on 155 term (≥37-≤42 weeks) antenatal women with hypertensive disorders of pregnancy fulfilling inclusion criteria. Immediately after delivery, arterial blood sample was drawn from doubly clamped 10-12 cm long umbilical cord in pre-heparinized insulin syringe, which was sent for pH estimation and 0.5 ml in lithium heparin tube for lactate dehydrogenase levels. One-and 5-min neonatal Apgar score was noted by pediatrician. Cord blood pH and lactate levels were then compared with overall neonatal outcome. Statistical analysis was done using SPSS-22 version. Results: Mean values of umbilical cord arterial pH and LDH was 7.2 ± 0.1 and 449.5 ± 562.9 U/L respectively. Significantly low mean cord blood pH (7.03 ± 0.12) and high LDH levels (939.74 ± 781.75 U/L) were observed in neonates of eclamptic mothers (p = 0.00). Mode of delivery had significant effects on cord blood parameters with significantly low pH and elevated LDH levels seen in neonates delivered by emergency LSCS for fetal distress (p < 0.05). Cord blood LDH levels were more significantly associated with NICU admission, neonatal morbidity and mortality. Cord blood LDH was a better predictor of neonatal outcome with 100% sensitivity and 79.73% specificity. Conclusion: Cord arterial blood lactate dehydrogenase levels were better predictor of overall neonatal outcome.

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Section: Tablesupporting

confidence: 71%

Role of umbilical cord arterial pH and lactate in newborn assessment of term antenatal women with hypertensive disorders of pregnancy

Kumar

Yadav

2020

Clinical Epidemiology and Global Health

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“…Foetal monitoring can be done by various methods like intermittent auscultation of foetal heart rate, electronic foetal monitoring in form of cardiotocography (CTG), biophysical profile, modified biophysical profile, contraction stress test, doppler velocimetry foetal scalp blood PH, and serum lactate level. [ 5 6 ]…”

Section: Introductionmentioning

confidence: 99%

Intrapartum cardiotocographic monitoring and its correlation with neonatal outcome

Kumar

Singh

Agarwal

et al. 2022

Journal of Family Medicine and Primary Care

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A BSTRACT Introduction: Despite the advancements in perinatal care in past decades, perinatal asphyxia remains a serious problem leading to significant perinatal morbidity and mortality. Therefore, foetal monitoring during the intrapartum period is of paramount importance. Among various methods of fetal monitoring, cardiotocography is a form of electronic foetal monitoring in which there is simultaneous recording of foetal heart rate and uterine contractions. Materials and Methods: This cross-sectional observational study was done in the labour room and neonatal intensive care unit (NICU) of a teaching Municipal Hospital in North India including 500 pregnant women of age group 18-45 years with singeleton fetus of gestation ≥36 weeks without any known congenital anomaly. Intrapartum cardiotocography (CTG) for 20 minutes was done within 12 hours prior to delivery and babies born to them were observed for birth asphyxia as Apgar score <7 at 1 minute as per using APGAR score less than 7 at 1 minute as per south east asia regional neonatal perinatal database (SEAR-NPD), world health organization (WHO) working definition. Results: CTG tracing was normal/reassuring in 92% of pregnant women, nonreassuring in 7% and was abnormal in only 1%. In patients with abnormal and nonreassuring CTG, delivery by lower segment cesarian section (LSCS) was significantly high ( P < .0001). APGAR scoring was done at 1 minute and 5 minutes of life, it was found that 4% babies were having score less than 7 at 1 minute with incidence of birth asphyxia 40 per 1,000 live births Neonatal seizure was significantly more in nonreassuring and abnormal CTG group ( P value <.0001). Conclusion: Abnormal CTG tracings result in higher incidence of operative interventions for deliveries. Abnormal CTG pattern during intrapartum CTG has high specificity and negative predictive value but has low sensitivity and positive predictive value for detection of birth asphyxia and need for NICU admission.

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“…In the study by Patil SS et al [20], 1.7% cases had convulsions within the first 24 hours after birth. Similar to our study, this was statistically insignificant.…”

Section: Discussionmentioning

confidence: 89%

“…In a study by Patil SS et al [20] who performed a similar study on 295 women, there was no association between need for NICU stay, acidosis at birth and CTG category.…”

Section: Discussionmentioning

confidence: 92%

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Is fetal CTG a reliable indicator of fetal distress? A prospective study on relationship between CTG suspected fetal distress and immediate postpartum umbilical cord blood pH.

et al. 2022

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Introduction: Perinatal asphyxia is one of the major causes of neonatal morbidity and mortality. Fetal Cardiotocography (CTG) has been used for long to predict fetal asphyxia. Despite its popularity, it has not been proved to be an ideal tool for monitoring as, although a normal trace is indicative of a normal acid-base status at birth, in about 98% of cases, an abnormal trace has a low positive predictive value in term of fetal acidosis (pH less than 7.25) .An undisputed evidence of perinatal asphyxia is metabolic acidosis on arterial cord blood or very early neonatal samples: pH< 7 and base deficit >12 mmol/L Aim: To see the correlation between suspicious/pathological CTG and umbilical cord blood pH at birth in term pregnancies.Material and methods: This was a hospital based prospective randomized observational study over a period of 1 year. It was conducted on 165 pregnant women with singleton term pregnancy admitted to labour ward for delivery and having suspicious / pathological CTG trace or meconium stained liquor with normal CTG trace. Immediately after the birth of the neonate, umbilical cord was clamped, cut and umbilical artery cord blood was collected in a pre -heparinized syringe and sent for pH analysis. Cord blood pH of less than 7.2 was interpreted as acidosis.Results: The number of acidotic cases (as determined by cord blood pH less than 7.2) was 2(5.6%) in normal traces whereas 34 cases (94.4%) of normal traces were non acidotic. In the suspicious traces, 2 cases (3.2%) were acidotic and 59 cases (96.8%) were non acidotic. In the pathological category, 13 cases (19.1%) were acidotic and 55 cases (80.9%) were non acidotic. There was no significant association of CTG category with cord blood pH, acidosis, pO2 or pCo2 values but that with presence of MSL and grade of MSL was statistically significant.Conclusion: Abnormal CTG while being a good predictor of the presence of MSL and also the grade of MSL, is a poor predictor of the presence of fetal acidosis and neonatal status after birth. Fetal monitoring using cardiotocography was associated with considerable false positive results. Thus, using fetal heart rate abnormalities alone as a measure of diagnosis of fetal distress during labour is a contributing factor of increasing rate of cesarean sections.

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Study on umbilical cord arterial blood gas analysis and cord blood lactate levels as predictors for adverse neonatal outcome: an observational study

Cited by 6 publications

References 7 publications

Role of umbilical cord arterial pH and lactate in newborn assessment of term antenatal women with hypertensive disorders of pregnancy

Role of umbilical cord arterial pH and lactate in newborn assessment of term antenatal women with hypertensive disorders of pregnancy

Intrapartum cardiotocographic monitoring and its correlation with neonatal outcome

Is fetal CTG a reliable indicator of fetal distress? A prospective study on relationship between CTG suspected fetal distress and immediate postpartum umbilical cord blood pH.

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