The influence of cord complications on fetal pH, neonatal APGAR score, and the acid base state and oxygenation of the umbilical artery and vein

Abstract

Continuous monitoring of fetal scalp tissue pH (tpH), acid base and oxygenation measurements of the blood of the umbilical artery and vein, and APGAR scoring was performed in 152 deliveries. The effect of cord complication on tpH (120, 90, 60, 30, 15, 10, 5, and 0 minutes before delivery), the status of the umbilical artery and vein (pH, pCO2, base excess, standard bicarbonate, pO2, and oxygen saturation), and the APGAR scores (one and five minutes after delivery) were investigated. Thirty-two per cent of the deliveries were associated with on or more cord complication(s). Cord complications in general did not influence the APGAR scores, the acid base state, or the oxygenation of the fetus and newborn. In the very few cases of tight cord complication(s) tpH showed a marked decrease during the last 30 minutes of labour, the umbilical blood was slightly acidotic, but the APGAR scores were normal (8-10 one and five minutes after delivery). No cases of prolapse of the cord were found. Cord complications are very common but in most cases completely harmless.

Thrombosis of the umbilical vessels revisited. An observational study of 317 consecutive autopsies at a single institution

“…The presence of thrombi in fact has been linked with fetal organ infarcts [5], cerebral palsy [6,7], massive fetomaternal hemorrhage [8], and fetal growth restriction [9]. Heifetz [1], in his recognized milestone review, reports an incidence of umbilical cord thrombosis of 1:1300 deliveries of uncomplicated pregnancies and of 1:1000 perinatal autopsies, with a significant increase to 1:250 in high-risk pregnancies.…”

Nuchal Cord and Perinatal Outcome in a Rural Hospital: A Case Control Study

“…Similar finding by other suggest that nuchal cords are not a major cause of foetal asphyxia. 3 In our study, Nuchal cord of any turns was not shown to be associated with intrauterine death or neonatal death. 12 ; however, in our study we observed that 4 neonates from nuchal cord group and 2 from non-nuchal cord group had Apgar score less than 7 at 1 minute.…”

“…2 , although this is controversial in the literature. [3,4,5] The presence of a nuchal cord is often cited as a major cause of foetal distress, as evidenced by meconium stained amniotic fluid or foetal bradycardia or tachycardia. [4,5] In our study, intrapartum foetal heart rate during 1 st stage of labour <110 beats per minute observed in 14 (28%) patients in nuchal cord group and 12 (24%) patients in non-nuchal cord group.…”

“…Several studies have shown that this cord compression results in reduced blood flow to the foetus and subsequent changes in the umbilical artery blood gases. 3 If compression is high enough to occlude the artery, the foetus is unable to exchange carbon dioxide adequately, resulting in hypercapnia and subsequent acidosis. Acidosis is significant, more common in newborns with nuchal cords.…”

Study of perinatal outcome of foetuses with nuchal cord

“…Nevertheless, in light of non-reassuring foetal heart rate patterns during labour and increased umbilical artery acidemia in nuchal cords together with decreased birth weight, the question needs to be raised of whether detecting of nuchal cord at admission for delivery has to be followed expectantly or whether active planning of delivery strategies in term pregnancies with nuchal cords is reasonable. 3 However, the insufficiency in data regarding the role of nuchal cord in foetal morbidity and mortality is a source of anxiety and frustration to both parturient and healthcare professionals Ultrasound detected nuchal cords have misguided several obstetricians and this has indirectly increased the rate of patients being operated for elective caesarean sections. 4 Considering the above facts the present study was taken up to establish the incidence of nuchal cord at delivery in the existing setup, intrapartum complications and the perinatal outcome that occurs in babies born with nuchal cord.…”