The role of umbilical cord gas studies in the prediction of adverse neonatal outcomes in scheduled nonlaboring term singleton cesarean deliveries

Gonen, Noa; Gluck, Ohad; Zussman, Noa Mevorach; Bar, Jacob; Kovo, Michal; Weiner, Eran

doi:10.1016/j.ajogmf.2019.06.001

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…The sample size also allowed us to assess the primary outcome by obesity class. Although a clear definition of pathologic fetal acidemia remains controversial, 16 we based our definition of fetal acidosis on a large cohort study by Yeh et al, 15 who determined that the risk of adverse neurologic sequelae increased with umbilical artery pH values less than 7.1. We excluded laboring patients to avoid confounding by labor processes and addressed other variables associated with uteroplacental insufficiency (eg, hypertension, diabetes) analytically.…”

Section: Discussionmentioning

confidence: 99%

“…Our finding of a 2.5% incidence of umbilical artery pH less than 7.1 is consistent with prior studies reporting umbilical artery pH less than 7.1 in 2-5% of cases. 16,[19][20][21] Other studies of term, scheduled cesarean delivery under neuraxial anesthesia have demonstrated that BMI was inversely correlated with umbilical artery pH 18,19 and positively correlated with base deficit. 18 Powell et al 20 determined that arterial pH was significantly lower in patients with BMIs higher than 40 undergoing scheduled cesarean delivery under neuraxial anesthesia but did not find an association between BMI and frequency of umbilical artery pH less than 7.1 or base deficit 12 mmol or greater.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] The absolute risk of neurologic sequelae, including hypoxic-ischemic encephalopathy (HIE), seizures, and death, is significantly increased with umbilical artery pH less than 7.1. 15 Although the utility of cord blood gas analysis to predict neonatal outcomes has been questioned, 16 another objective measure has yet to be elucidated.…”

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confidence: 99%

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Association Between Obesity and Fetal Acidosis at Scheduled Cesarean Delivery

DeBolt

Sarker

Trejo

et al. 2022

Obstetrics &Amp; Gynecology

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To evaluate whether patients with obesity who undergo scheduled cesarean delivery under neuraxial anesthesia are at increased risk for umbilical artery pH less than 7.1 and base deficit 12 mmol or greater. METHODS:We conducted a multicenter, retrospective cohort study of individuals who delivered a term, singleton, nonanomalous neonate at one of four academic medical centers in New York City from 2013 to 2019 by scheduled cesarean under neuraxial anesthesia for whom fetal cord blood gas results were available. The primary study outcome was rate of fetal acidosis, defined as umbilical artery pH less than 7.1. This was compared between patients with obesity (body mass index [BMI] 30 or higher) and those without obesity (BMI lower than 30). Base deficit 12 mmol or greater and a composite of fetal acidosis and base deficit 12 mmol or greater were also compared. Secondary outcomes included neonatal intensive care unit admission rate, 5-minute Apgar score less than 7, and neonatal morbidity. Associations between maternal BMI and study outcomes were assessed using multivariable logistic or linear regression and adjusted for age, race and ethnicity, insurance type, cesarean delivery order number, and neuraxial anesthesia type. RESULTS:Of the 6,264 individuals who met inclusion criteria during the study interval, 3,098 had obesity and 3,166 did not. The overall rate of umbilical artery cord pH less than 7.1 was 2.5%, and the overall rate of umbilical artery base deficit 12 mmol or greater was 1.5%. Patients with obesity were more likely to have umbilical artery cord pH less than 7.1 (adjusted odds ratio [aOR] 2.7, 95% CI 1.8-4.2) and umbilical artery base deficit 12 mmol or greater (aOR 3.2, 95% CI 1.9-5.3). This association was not significantly attenuated after additional adjustments for potential mediators, including maternal medical comorbidities. We found no differences in secondary outcomes between groups.CONCLUSION: Maternal obesity is associated with increased odds of arterial pH less than 7.1 and base deficit 12 mmol or greater at the time of scheduled cesarean delivery under neuraxial anesthesia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association Between Obesity and Fetal Acidosis at Scheduled Cesarean Delivery

DeBolt

Sarker

Trejo

et al. 2022

Obstetrics &Amp; Gynecology

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“…Naturally, prospective clinical evaluations are needed. Despite the clear potential of many HRV metrics to predict fetal acidemia, the proxy of fetal acidemia itself has been proven to not be appropriate for predicting clinical outcome ( 11 , 12 ). As such, while to date, most studies in the field have sought to predict pH at birth, some studies in this Research Topic and elsewhere have sought to predict physiologically more direct outcomes related to fetal compromise, either using FHR data as time series or as scanned CTG tracings ( Gold et al ; Roux et al ).…”

Section: Systematic Reviewsmentioning

confidence: 99%

Editorial: Fetal-maternal monitoring in the age of artificial intelligence and computer-aided decision support: A multidisciplinary perspective

et al. 2022

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“…Most trials on therapeutic hypothermia, a treatment that increases survival without increasing major disability in term and late preterm infants with moderate or severe encephalopathy and evidence of intrapartum asphyxia, have applied Apgar scores and UA pH as criteria for peripartum asphyxia [ 24 ]. While the Apgar score is routinely used after birth, the determination of UA blood pH is not yet so widespread, or is only recommended in certain situations [ 4 , 25 ]. However, fetal acidosis with a higher risk of adverse outcomes was also present in neonates with a 5-min Apgar score ≥ 7, demonstrating that clinical aspects alone are not sufficient to assess the neonate [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Trends in Apgar scores and umbilical artery pH: a population-based cohort study on 10,696,831 live births in Germany, 2008–2022

Boos,

Bührer

2024

Eur J Pediatr

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Low Apgar scores and low umbilical arterial (UA) blood pH are considered indicators of adverse perinatal events. This study investigated trends of these perinatal health indicators in Germany. Perinatal data on 10,696,831 in-hospital live births from 2008 to 2022 were obtained from quality assurance institutes. Joinpoint regression analysis was used to quantify trends of low Apgar score and UA pH. Additional analyses stratified by mode of delivery were performed on term singletons with cephalic presentation. Robustness against unmeasured confounding was analyzed using the E-value sensitivity analysis. The overall rates of 5-min Apgar scores < 7 and UA pH < 7.10 in liveborn infants were 1.17% and 1.98%, respectively. For low Apgar scores, joinpoint analysis revealed an increase from 2008 to 2011 (annual percent change (APC) 5.19; 95% CI 3.66–9.00) followed by a slower increase from 2011 to 2019 (APC 2.56; 95% CI 2.00–3.03) and a stabilization from 2019 onwards (APC − 0.64; 95% CI − 3.60 to 0.62). The rate of UA blood pH < 7.10 increased significantly between 2011 and 2017 (APC 5.90; 95% CI 5.15–7.42). For term singletons in cephalic presentation, the risk amplification of low Apgar scores was highest after instrumental delivery (risk ratio 1.623, 95% CI 1.509–1.745), whereas those born spontaneous had the highest increase in pH < 7.10 (risk ratio 1.648, 95% CI 1.615–1.682). Conclusion: Rates of low 5-min Apgar scores and UA pH in liveborn infants increased from 2008 to 2022 in Germany. What is Known:• Low Apgar scores at 5 min after birth and umbilical arterial blood pH are associated with adverse perinatal outcomes.• Prospective collection of Apgar scores and arterial blood pH data allows for nationwide quality assurance. What is New:• The rates of liveborn infants with 5-min Apgar scores < 7 rose from 0.97 to 1.30% and that of umbilical arterial blood pH < 7.10 from 1.55 to 2.30% between 2008–2010 and 2020–2022. • In spontaneously born term singletons in cephalic presentation, the rate of metabolic acidosis with pH < 7.10 and BE < −5 mmol/L in umbilical arterial blood roughly doubled between the periods 2008–2010 and 2020–2022.

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The role of umbilical cord gas studies in the prediction of adverse neonatal outcomes in scheduled nonlaboring term singleton cesarean deliveries

Cited by 6 publications

References 18 publications

Association Between Obesity and Fetal Acidosis at Scheduled Cesarean Delivery

Association Between Obesity and Fetal Acidosis at Scheduled Cesarean Delivery

Editorial: Fetal-maternal monitoring in the age of artificial intelligence and computer-aided decision support: A multidisciplinary perspective

Trends in Apgar scores and umbilical artery pH: a population-based cohort study on 10,696,831 live births in Germany, 2008–2022

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