Umbilical Cord Arterial Blood Gas and Apgar Score: Who Is at Higher Risk?

Document Type: Original Article

Authors

1 Department of Obstetrics and Gynecology, Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences, Gorgan, Iran School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Obstetrics and Gynecology, Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences, Gorgan, Iran

3 Children’s and Neonatal Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Children’s and Neonatal Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran

Abstract

Background: Fetal asphyxia and the consequent neurological damages could be avoided if the risk factors are controlled at earlier stages. Umbilical cord arterial blood gas (UCABG) seems to be related to the Apgar scores, as well as the neonatal morbidity and mortality rates. Therefore, we designed this study to assess the correlation between the Apgar score and UCABG in Northeast of Iran.
Methods: This case-control study evaluated 438 term newborns and 62 preterm infants born during 2012-2013. Peripartum asphyxia, admission in the neonatal intensive care unit, and death were recorded as outcome measures. All the data were analyzed using the t-test and logistic regression analysis.
Results: Mild to moderate acidemia (pH=7-7.2) was reported in 9.6% and severe acidemia (PH<7) was observed in 1% of the participants. Multivariate analysis showed that aspiration of amniotic fluid, umbilical cord pH ≤ 7.2, umbilical cord base excess, and being preterm could be considered as the predictors of lower first-minute Apgar score.
Conclusion: Umbilical cord blood gas measurement is a useful tool to detect the neonates who are at higher risk of low Apgar.

Keywords


1. Mokarami P. Pitfalls in interpreting umbilical cord blood gases and lactate at birth. Lund, Sweden: Lund University; 2013.

 2. Victory R, Penava D, Da Silva O, Natale R, Richardson B. Umbilical cord pH and base excess values in relation to adverse outcome events for infants delivering at term. Am J Obstet Gynecol. 2004; 191(6):2021-8.

3. Yeh P, Emary K, Impey L. The relationship between umbilical cord arterial pH and serious adverse neonatal outcome: analysis of 51,519 consecutive validated samples. BJOG. 2012; 119(7):824-31.

4. Modarressnejad V. Umbilical cord blood pH and risk factors for acidaemia in neonates in Kerman. East Mediterr Health J. 2005; 11(1-2):96-101.

5. Leuthner SR, Das UG. Low Apgar scores and the definition of birth asphyxia. Pediatr Clin North Am. 2004; 51(3):737-45.

 6. Maghsoudloo M, Eftekhar N, Ashraf MA, Khan ZH, Sereshkeh HP. Does intravenous fentanyl affect Apgar scores and umbilical vessel blood gas parameters in cesarean section under general anesthesia? Acta Med Iran. 2011; 49(8):517-22.

 7. Hermansen MC. The acidosis paradox: asphyxial brain injury without coincident acidemia. Dev Med Child Neurol. 2003; 45(5):353-6.

8. Impey L, Greenwood C, MacQuillan K, Reynolds M, Sheil O. Fever in labour and neonatal encephalopathy: a prospective cohort study. BJOG. 2001; 108(6):594-7.

 9. Graham EM, Ruis KA, Hartman AL, Northington FJ, Fox HE. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol. 2008; 199(6):587-95.

 10. Rezaee M, Jahanshahifard S, Heidari S. Association between Apgar score, umbilical artery cord pH and base excess in the first hour of birth in neonates. J Urmia Nurs Midwifery Facul. 2014; 12(2):144-52.

 11. Ahmadpour-Kacho M, Asnafi N, Javadian M, Hajiahmadi M, Taleghani N. Correlation between umbilical cord pH and Apgar score in high-risk pregnancy. Iran J Pediatr. 2010; 20(4):401-6.

 12. Raafati S, Borna H, Tehrani FH, Nodoshan MJ, Mozafari MJ, Eslami M. Neonatal Apgar scores and umbilical blood gas changes in vaginal delivery and cesarean: a comparative study. Tehran Univ Med J. 2006; 64(4):61-8.

 13. Kaveh M, Davari FT, Farahani M. Apgar score and arterial blood gas in the first hour of birth in neonates. Iran J Pediatr. 2004; 14(1):27-32.