Cord blood sampling at delivery: do we need to always collect from both vessels?

Tong, Stephen; Egan, Val; Griffin, Julie; Wallace, Euan

doi:10.1111/j.1471-0528.2002.01072.x

Cited by 24 publications

(15 citation statements)

References 6 publications

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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%

“…There is a growing body of support for umbilical cord blood gas (UCBG) analysis to be undertaken on all deliveries to provide an objective marker of neonatal biochemical status at delivery 1-6 that in turn can identify neonates that have been exposed to perinatal asphyxial insults. Although some authors have advocated sampling only the umbilical artery, 7 the majority of authors and professional societies strongly advocate obtaining and analysing samples from both the umbilical artery and vein [8][9][10][11][12] to ensure the biological validity of the blood gas values obtained.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…Importantly, the previous report was of only 17 pregnancies compared with 141 here. In addition, the arterial samples in the current study were validated according to agreed criteria, 10,11 whereas this was not undertaken in the prior report. Accordingly, we believe that the current data are more likely to be truly representative, and therefore that umbilical artery activin A is not likely to be useful as a marker of fetoplacental oxygenation at the time of delivery.…”

Section: Discussionmentioning

confidence: 99%

“…vein instead of artery). 10,11 Therefore, only validated samples, using previously proposed criteria, 10,11 were utilised in this study. Briefly, samples were considered valid only when umbilical vein pH was > 0.02 and CO 2 < À4 mmHg, relative to the artery.…”

Section: Methodsmentioning

confidence: 99%

Fetal activin A: associations with labour, umbilical artery pH and neonatal outcome

Tong

Egan

Wallace

2004

BJOG

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Objective To define the ontogeny of umbilical artery activin A at term and to evaluate activin A as a potential marker of perinatal hypoxia. Design A cohort study.Setting A university teaching hospital delivery suite.Population A convenience sample of 141 term pregnancies.Methods At delivery, umbilical artery and vein bloods were collected for blood gas measurements and subsequent measurement of activin A. Activin A levels were correlated with blood gas measurements and with labour and neonatal outcomes. Main outcome measures Umbilical arterial activin A and pH.Results The median (95% CI) umbilical arterial activin A level at delivery was 1.38 (1.34 -1.70) ng/mL. Levels varied significantly across gestation ( P ¼ 0.03), increasing from 36 to 38 weeks, thereafter decreasing to a nadir at 41 weeks. In 60 matched samples, the median (95% CI) venous and arterial activin A levels were 0.89 (0.81 -1.06) ng/mL and 1.38 (1.21 -1.61) ng/mL, respectively ( P < 0.0001). Mean umbilical arterial pH was 7.20 (7.06 -7.38; 5 -95th centiles) and was not significantly correlated with log 10 activin A (r ¼ À 0.01; P ¼ 0.68). Compared with healthy controls, there was no difference in arterial activin A in neonates identified as having suffered significant intrapartum asphyxia ( P ¼ 0.96). Fetal activin A levels were significantly lower in cases delivered by emergency caesarean section for complications during the first stage of labour compared with cases delivered vaginally ( P ¼ 0.003). Conclusions Umbilical artery activin A does not appear to be a sensitive marker of fetal oxygenation or of risk of hypoxic -ischaemic encephalopathy.

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“…8 Previous studies have shown that universal UCBGA can reduce the proportion of hypoxic children over time, and a cost-effectiveness analysis showed that changing the recommendation from selective to universal UCBGA reduced costs, mainly through a reduction in admissions to special care nursery for children with birthweight >2499 g. 8,9 In settings where universal measurement of UCBGA is recommended, mostly single hospitals or administrative regions, the proportion of births with UCBGA varies from 49% in Alabama, USA, to 81% in Victoria, Australia, with UCBGA still missing in a substantial proportion of births. 5,10,11 Prior to 2009 policy in Danish maternity wards varied from no UCBGA to UCBGA in cases with suspicion of hypoxia. In 2009 the Danish Society of Obstetrics and Gynecology introduced a national recommendation of universal measurement of umbilical cord pH (UC-pH) as part of UCBGA.…”

Section: Introductionmentioning

confidence: 99%

Implementation of universal umbilical cord pH analysis in Denmark. A national register‐based study

Andersson

Thellesen

Kesmodel

et al. 2023

Acta Obstet Gynecol Scand

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Introduction:Umbilical cord blood gas analysis provides information about intrapartum hypoxia and is considered an important measure of quality in maternity care.Universal measurement of umbilical cord pH (UC-pH), as part of umbilical cord blood gas analysis, has been recommended in Denmark since 2009. The recommendation is that UC-pH is measured from the umbilical cord artery (pH UA ) and vein (pH UV ). The aim of this study was to evaluate the national implementation of universal measurement of UC-pH. Material and methods:The study consisted of two parts. First, an evaluation of the implementation, that is, the proportion of births with measured UC-pH since the recommendation was introduced. Second, an evaluation of the cases in which UC-pH was missing. This analysis only involved births with gestational age ≥35 + 0 weeks. Results:In the period 2009 to 2018 there were 560 889 singleton, live births with registered gestational age in Denmark. The proportion of births with measured pH UA and pH UV increased from 12.4% in 2009 to 82.8% in 2015 and then declined to 76.9% in 2018 (p < 0.001). When comparing the group with missing pH from one or both vessels to the group with both pH UA and pH UV we found lower occurrence of pregnancy and births complications in the first group, body mass index ≥35 (unadjusted RR: 0.

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Cord blood sampling at delivery: do we need to always collect from both vessels?

Cited by 24 publications

References 6 publications

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

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

Fetal activin A: associations with labour, umbilical artery pH and neonatal outcome

Implementation of universal umbilical cord pH analysis in Denmark. A national register‐based study

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