Indicators of umbilical arterial blood acid-base status during spontaneous labor and cesarean section
- Authors: Prikhodko A.M.1, Baev O.R.1, Evgrafova A.V.1, Romanov A.Y.1, Degtyarev D.N.1
-
Affiliations:
- Academician V. I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
- Issue: No 12 (2019)
- Pages: 82-88
- Section: Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/248672
- DOI: https://doi.org/10.18565/aig.2019.12.83-89
- ID: 248672
Cite item
Abstract
Objective. To comparatively analyze the data on the umbilical arterial blood acid-base status in healthy newborn infants according to the method of delivery. Subjects and methods. The prospective examination covered the results of umbilical arterial blood (UCAB) gas analysis in 280 healthy newborns: 152 babies after spontaneous labor, 62 after cesarean section (CS) before the beginning of delivery, and 66 after CS during labor for reasons unrelated to hypoxia. Results. The mean umbilical arterial blood pH value during spontaneous labor was 7.28 (0.09) and was significantly lower than that in patients undergoing CS before delivery (7.34 (0.06) (p <0.001)). The base deficiency level during spontaneous labor was 7.4 (3.1) versus 2.8 (1.7) mmol/L in those undergoing CS before labor and 5.9 (3.0) during labor (p = 0.007). The level of lactate during spontaneous labor was 5.4 (2.0) and was much higher than in CS before delivery (2.1 (0.8)) and during labor (2.8 (1.9)) (p = 0, 0007). The partial pressure of carbon dioxide and oxygen was not different. Conclusion. The findings showed significant differences in the UCAB acid-base status after labor and CS done before the beginning of delivery. These differences must be considered when evaluating the status of a newborn infant. Even the clinically healthy newborns have a wide range of fluctuations in pH values, base deficiency, and cord blood lactate after both labor and CS. In some observations, there is a mismatch between cardiotocographic data at the birth, the satisfactory status of newborn health, and changes in the UCAB acid-base status.
Keywords
Full Text
![Restricted Access](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_lock.png)
About the authors
Andrey M. Prikhodko
Academician V. I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: a_prikhodko@oparina4.ru
Oleg R. Baev
Academician V. I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: o_baev@oparina4.ru
Alexandra V. Evgrafova
Academician V. I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: a_evgrafova@oparina4.ru
Andrey Yu. Romanov
Academician V. I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: romanovl553@yandex.ru
Dmitriy N. Degtyarev
Academician V. I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of RussiaReferences
- MacLennan A. A template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement. BMJ. 1999; 319(7216): 1054-9. doi: 10.1136/bmj.319.7216.1054
- Hankins G.D. V, Speer M. Defining the pathogenesis and pathophysiology of neonatal encephalopathy and cerebral palsy. Obstet Gynecol. 2003; 102(3): 628-36. doi: 10.1038/sj.jp.7210912
- Приходько А.М., Романов А.Ю., Шуклина Д.А., Баев О.Р. Показатели кислотно-основного равновесия и газовый состав артериальной и венозной пуповинной крови в норме и при гипоксии плода. Акушерство и гинекология. 2019; (2): 93-7.
- Chauhan S.P., Cowan B.D., Meydrech E.F., Magann E.F., Morrison J.C., Martin J.N. Determination of fetal acidemia at birth from a remote umbilical arterial blood gas analysis. Am J Obstet Gynecol. 1994; 170(6): 1705-9; discussion 1709-12. doi: 10.1016/S0002-9378(12)91839-6
- Goodwin T.M., Belai I., Hernandez P., Durand M., Paul R.H. Asphyxial complications in the term newborn with severe umbilical acidemia. Am J Obstet Gynecol. 1992; 167(6): 1506-12. doi: 10.1016/0002-9378(92)91728-s
- Ferreira C.S., Melo A., Fachada A.H., Solheiro H., Nogueira Martins N. Umbilical Cord Blood Gas Analysis, Obstetric Performance and Perinatal Outcome. Rev Bras Ginecol Obstet. 2018; 40(12):740-8. doi: 10.1055/s-0038-1675187.
- Maisonneuve E., Audibert F., Guilbaud L., Lathelize J., Jousse M., Pierre F., et al. Risk factors for severe neonatal acidosis. Obstet Gynecol. 2011; 118(4): 818-23. doi: 10.1097/AOG.0b013e31822c9198.
- Belfort M.A., Saade G.R., Thom E., Blackwell S.C., Reddy U.M., Thorp J.M., et al. A Randomized Trial of Intrapartum Fetal ECG ST-Segment Analysis. N Engl J Med. 2015; 373(7): 632-41. doi: 10.1056/NEJMoa1500600.
- Bernardes T.P, Broekhuijsen K., Koopmans C.M., Boers K.E., van Wyk L., Tajik P., et al. Caesarean section rates and adverse neonatal outcomes after induction of labour versus expectant management in women with an unripe cervix: a secondary analysis of the HYPITAT and DIGITAT trials. BJOG. 2016; 123(9): 1501-8. doi: 10.1111/1471-0528.14028.
- Bullens L.M., Smith J.S., Truijens S.E.M., van der Hout-van der Jagt M.B., van Runnard Heimel P.J., Oei S.G. Maternal hemoglobin level and its relation to fetal distress, mode of delivery, and short-term neonatal outcome: a retrospective cohort study. J Matern Fetal Neonatal Med. 2019; 1-7. doi: 10.1080/14767058.2019.1573221.
- Hulsenboom A.D.J., Verdurmen K.M.J., Vullings R., van der Hout-van der Jagt M.B., Kwee A., van Laar J.O.E.H., et al. Relative versus absolute rises in T/QRS ratio by ST analysis of fetal electrocardiograms in labour: A case-control pilot study. Pueyo E, editor. PLoS One. 2019; 14(3): e0214357. doi: 10.1371/journal. pone.0214357.
- Tomimatsu T., Kakigano A, Mimura K., Kanayama T., Koyama S., Fujita S., et al. Maternal hyperventilation during labor revisited: its effects on fetal oxygenation. Reprod Sci. 2012; 19(11): 1169-74. doi: 10.1177/1933719112443881.
- Elbay A., Celik U., Celik B., Ozer O.F., Kilic G., Akkan J.C.U., et al. Intraocular pressure in infants and its association with hormonal changes with vaginal birth versus cesarean section. Int Ophthalmol. 2016; 36(6): 855-60. doi: 10.1007/ s10792-016-0215-6.
- Limesand S.W., Rozance P.J. Fetal adaptations in insulin secretion result from high catecholamines during placental insufficiency. J Physiol. 2017; 595(15): 5103-13. doi: 10.1113/JP273324.
- Landau R., Liu S.-K., Blouin J.-L., Smiley R.M., Ngan Kee W.D. The effect of maternal and fetal [32-adrenoceptor and nitric oxide synthase genotype on vasopressor requirement and fetal acid-base status during spinal anesthesia for cesarean delivery. Anesth Analg. 2011; 112(6): 1432-7. doi: 10.1213/ ANE.0b013e3182179424.
- Приходько А.М., Киртбая А.Р., Романов А.Ю., Баев О.Р. Биомаркеры повреждения головного мозга у новорожденных. Неонатология. 2018; 7(1): 70-6. [Prikhod’ko A.M., Kirtbaya A.R., Romanov A. Yu., Baev O.R. Biomarkers of brain damage in newborns. Neonatologija. 2018; 7(1): 70-6.(in Russian)]. doi: 10.24411/2308-2402-2018-00009
- Приходько А.М., Баев О.Р. Определение кислотно-основного состояния пуповинной крови. Показания и техника. Акушерство и гинекология. 2018; (5): 127-31. [Prikhodko A.M., Baev O.R. Determination of umbilical cord blood acid-base status. Indications and techniques. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (5): 127-31. (in Russian)]. doi: 10.18565/aig.2018.5.127-131
- Ayres-de-Campos D., Spong C.Y., Chandraharan E., FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J Gynaecol Obstet. 2015; 131(1): 13-24. doi: 10.1016/j.ijgo.2015.06.020.
- Araujo O.R., Diegues A.R., Silva D.C.B. da, Albertoni A. de C.S., Louzada M.E.R., Cabral E.A.F., et al. Agreement and correlation of pH, bicarbonate, base excess and lactate measurements in venous and arterial blood of premature and term infants. Rev Bras Ter intensiva. 2007; 19(3): 322-6. doi: 10.1590/S0103-507X2007000300009
- Nordstrom L., Achanna S., Naka K., Arulkumaran S. Fetal and maternal lactate increase during active second stage of labour. BJOG. 2001; 108(3): 263-8. doi: 10.1111/j.1471-0528.2001.00034.x
- Qian G., Xu X., Chen L., Xia S., Wang A., Chuai Y., et al. The effect of maternal low flow oxygen administration during the second stage of labour on umbilical cord artery pH: a randomised controlled trial. BJOG An Int J Obstet Gynaecol. 2017; 124(4): 678-85. doi: 10.1111/1471-0528.14418.
- Chou Y.H., Tsou Yau K.I., Wang P.J. Clinical application of the measurement of cord plasma lactate and pyruvate in the assessment of high-risk neonates. Acta Paediatr. 1998; 87(7):764-8. doi: 10.1080/080352598750013851
Supplementary files
![](/img/style/loading.gif)