Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit

White, C. J.; Doherty, Dorota; Henderson, Jennifer; Kohan, Rolland; Newnham, John P.; Pennell, Craig E.

doi:10.1111/j.1479-828x.2010.01192.x

Cited by 46 publications

(35 citation statements)

References 32 publications

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“…The differences are likely attributable to studies using hemolyzed or whole blood samples, and differences in lactate assays, study populations and outcome measures. While many collected paired arterial and venous lactate, they did not report the ability of venous lactate to predict arterial lactic acidemia or neonatal outcomes [12, 28, 29]. The differences between mean arterial and venous lactate levels were 0.2 to 0.5 mmol/L, which is consistent with the 0.34 mmol/L we observed in the present study [12, 28, 29].…”

Section: Discussionsupporting

confidence: 83%

“…Lactate has the additional advantage of being measured directly as opposed to base excess which is calculated using algorithms that may differ by the gas analyser used [8]. However it is not always feasible to obtain umbilical arterial blood at delivery [9–12]. Umbilical venous blood is much more readily obtainable because of the larger size of the umbilical vein.…”

Section: Introductionmentioning

confidence: 99%

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Umbilical Cord Venous Lactate for Predicting Arterial Lactic Acidemia and Neonatal Morbidity at Term

Tuuli

Stout

Macones

et al. 2016

Obstetrics &Amp; Gynecology

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Objective To estimate the utility of umbilical venous lactate, more readily available than umbilcal cord arterial lactate, for predicting arterial lactic acidemia and neonatal outcomes at term. Methods This was a prospective cohort study of consecutive, non-anomalous, singleton, term births following labor in a large academic medical center (2009 – 2014). Umbilical arterial and venous lactate were measured immediately after delivery, prior to knowledge of neonatal outcomes. The outcome measures were arterial lactic acidemia (>3.9mmol/L) and a composite neonatal outcome consisting of neonatal death and any of a number of neonatal morbidities including intubation, mechanical ventilation, meconium aspiration syndrome, hypoxic-ischemic encephalopathy, and therapeutic hypothermia. Predictive ability of venous lactate was estimated using the area under the receiver-operating characteristics curve (AUC). Results Among 7,741 births, venous lactate was strongly predictive of arterial lactic acidemia (AUC=0.958). The ‘optimal’ cut-point of venous lactate for predicting both arterial lactic acidemia and the composite neonatal outcome was 3.4mmol/L This predicted arterial lactic acidemia with sensitivity of 87.0% and specificity of 91.3%. Positive and negative predictive values were 79.9% and 94.7%, respectively. The composite neonatal outcome occurred in 104 neonates (1.3%). Compared with arterial lactate, venous lactate predicted the composite neonatal outcome with comparable sensitivity (75.0% versus 74.0%, P>0.99), but slightly lower specificity (69.7% versus 72.2%, P<0.01). Conclusion Umbilical venous lactate strongly predicts arterial lactic acidemia and is comparable to arterial lactate for predicting neonatal morbidity at term. It could be used as a measure of neonatal morbidity when arterial blood is not available.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Umbilical Cord Venous Lactate for Predicting Arterial Lactic Acidemia and Neonatal Morbidity at Term

Tuuli

Stout

Macones

et al. 2016

Obstetrics &Amp; Gynecology

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“…Historically, the proportion of samples declared nonvalid varies from 5 to 37% of the population evaluated. 3,7,11,13,[21][22][23][24][25][26][27][28] Apart from the inability to obtain an arterial and/or venous sample, the most common postulated mistake is the inadvertent switching of umbilical arterial and venous samples or sampling the same umbilical vessel twice (typically the umbilical vein). Early studies of UCBG values relied on the skill of the midwifery and medical staff members' sampling technique, and typically only reported values from a single umbilical vessel.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of selection criteria for validating paired umbilical cord blood gas samples: an observational study

White

Doherty

Kohan

et al. 2012

BJOG

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Objective To compare six validation criteria for umbilical cord blood gas (UCBG) values in vigorous and nonvigorous neonates.Design Retrospective cohort study.Setting Single tertiary obstetric centre, King Edward Memorial Hospital (KEMH), Perth, Western Australia.Sample A total of 37 763 consecutive deliveries at >23 weeks of gestation.Methods Six validation criteria were compared to evaluate the proportion of deliveries with 'valid' UCBG data; and the proportion of vigorous and nonvigorous neonates with metabolic acidaemia.Main outcomes Proportion of deliveries with 'valid' UCBG values; proportions of vigorous and nonvigorous neonates with normal, borderline and abnormal UCBG values.Results The criteria based on KEMH 5th centile arteriovenous pH and Pco 2 differences resulted in a higher proportion of neonates with 'valid' UCBG values than the previously described Westgate and Kro criteria. The increase in 'valid' UCBG values occurred across the entire study population including vigorous and nonvigorous neonates. Among neonates with short-term neonatal complications there was an increase in nonvigorous neonates with umbilical artery metabolic acidaemia. There was no corresponding increase in vigorous neonates diagnosed with abnormal UCBG values.Conclusions Use of the KEMH criteria results in an increase in the proportion of nonvigorous term neonates with UCBG data considered 'valid' to aid clinicians in the management of the neonate shortly after delivery. This change occurs without increasing the rate of false-positive diagnoses of acidaemia in vigorous neonates. The KEMH 'validation' criteria were developed from an entire presenting population and provide a simple algorithm that can be universally applied to identify neonates with nonphysiological UCBG values.

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“…Adverse outcomes included: a 5 min Apgar score of < seven, lactate values suggestive of acidosis (umbilical artery lactate values of > 7 mmol/L) and/or the necessity of neonatal resuscitation [14, 15]. …”

Section: Methodsmentioning

confidence: 99%

Evidence of lower oxygen reserves during labour in the growth restricted human foetus: a retrospective study

Parisi

Monzeglio

Attini

et al. 2017

BMC Pregnancy Childbirth

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BackgroundThe aim of the present study is to test the hypothesis that Growth Restricted foetuses (FGR) have the tendency to develop more pathological cardiotocograpic tracings during labour than do appropriate for gestational age foetuses and that there is a shorter time lapse from the beginning of labour and the advent of a pathological cardiotocograpic tracing.MethodsThe study was carried out at the Maternal-Foetal Medicine Unit of the Sant’Anna University Hospital, Turin, Italy. A total of 930 foetuses born at term between January and December 2012 were analysed: 355 small for gestational age (SGA) comprising both constitutional small for gestational age and growth restricted foetuses (cases group) and 575 Appropriate for Gestational Age (AGA) foetuses (control group). Tracings were evaluated independently by two obstetric consultants, according to the International Federation of Gynaecology and Obstetrics (FIGO) classification. The main outcomes considered were the incidence of pathological cardiotocograpic tracings and the time interval between the beginning of labour and the advent of pathological cardiotocograpic tracing.The Student’s t-test, chi-square test and ANOVA were used for comparisons between cases and controls and amongst groups. Significance was set at <0.05. Univariate and multivariate odds-ratios were calculated.ResultsFoetuses with birthweight <3rd centile (growth restricted foetuses) more frequently presented pathological cardiotocograpic tracings in labour than did controls (43.8% vs. 21.6%; p < 0.001). Pathological cardiotocograpic tracing developed faster in the foetuses with birthweight <3rd centile group (53′, 0′-277′) than it did in the control group (170.5′, 0′-550′; p < 0.05).A higher induction rate was observed in the cases (29.6%) than in the control group (17%), with statistical significance p < 0.001. To correct for this possible confounding factor a multivariate logistic regression analysis was performed. It confirmed a statistically significant increased risk of pathological cardiotocographic tracings in the FGR group (OR 1.63; CI 1.30–2.05).ConclusionThe results confirm the hypothesis that Growth Restricted foetuses (FGR) have fewer oxygen reserves to deal with labour. Our results underscore the importance of the prenatal detection of these foetuses and of their continuous cardiotocographic monitoring during labour.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1392-7) contains supplementary material, which is available to authorized users.

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Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit

Cited by 46 publications

References 32 publications

Umbilical Cord Venous Lactate for Predicting Arterial Lactic Acidemia and Neonatal Morbidity at Term

Umbilical Cord Venous Lactate for Predicting Arterial Lactic Acidemia and Neonatal Morbidity at Term

Evaluation of selection criteria for validating paired umbilical cord blood gas samples: an observational study

Evidence of lower oxygen reserves during labour in the growth restricted human foetus: a retrospective study

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