Umbilical Cord Oxygen Content and Neonatal Morbidity at Term
03 June 2017
14 September 2017
11 October 2017 (eFirst)
Objective The objective of this study was to investigate the relationship between umbilical cord partial pressure of oxygen (pO2) at delivery and neonatal morbidity.
Study Design This is a secondary analysis of a prospective cohort study of term deliveries with universal cord gas collection between 2010 and 2014. The primary composite outcome of neonatal morbidity included neonatal death, meconium aspiration syndrome, intubation, mechanical ventilation, hypoxic-ischemic encephalopathy, and hypothermia treatment. Umbilical artery (UA), vein (UV), UV minus UA (Δ) pO2, and hypoxemia (pO2 ≤ fifth percentile) were compared between patients with and without neonatal morbidity. Areas under the receiver-operating characteristic curves were used to assess the predictive ability of pO2.
Results Of 7,789 patients with paired umbilical cord pO2, 106 (1.4%) had the composite neonatal morbidity. UA pO2 was significantly lower in patients with neonatal morbidity compared with those without (median [interquartile range]: 16 (12, 21) vs. 19 (15, 24) mm Hg, p < 0.001). There was no difference in median UV pO2 or ΔpO2 between the groups. UA and UV hypoxemia were significantly more common in patients with neonatal morbidity. UA pO2 had limited predictive ability for neonatal morbidity (area under the curve: 0.61, 95% confidence interval: 0.6–0.7).
Conclusion Although UA pO2 is significantly lower in patients with neonatal morbidity, it is a poor predictor of neonatal morbidity at term.
This study was presented at the Society for Reproductive Investigation Annual Meeting, March 15–18, 2017, Orlando, Florida.
- 1 Executive summary: neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy. Obstet Gynecol 2014; 123 (04) 896-901
- 2 Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis. BMJ 2010; 340: c1471
- 3 Page FO, Martin JN, Palmer SM. , et al. Correlation of neonatal acid-base status with Apgar scores and fetal heart rate tracings. Am J Obstet Gynecol 1986; 154 (06) 1306-1311
- 4 Caravale B, Allemand F, Libenson MH. Factors predictive of seizures and neurologic outcome in perinatal depression. Pediatr Neurol 2003; 29 (01) 18-25
- 5 Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR, Greene MF. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice, 7th ed. Philadelphia, PA: Saunders/Elsevier; 2009
- 6 Tuuli MG, Stout MJ, Shanks A, Odibo AO, Macones GA, Cahill AG. Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term. Obstet Gynecol 2014; 124 (04) 756-761
- 7 Gjerris AC, Staer-Jensen J, Jørgensen JS, Bergholt T, Nickelsen C. Umbilical cord blood lactate: a valuable tool in the assessment of fetal metabolic acidosis. Eur J Obstet Gynecol Reprod Biol 2008; 139 (01) 16-20
- 8 Bloom SL, Swindle RG, McIntire DD, Leveno KJ. Fetal pulse oximetry: duration of desaturation and intrapartum outcome. Obstet Gynecol 1999; 93 (06) 1036-1040
- 9 East CE, Begg L, Colditz PB, Lau R. Fetal pulse oximetry for fetal assessment in labour. Cochrane Database Syst Rev 2014; (10) CD004075
- 10 Csitári IK, Pasztuhov A, László A. The reliability of fetal pulse oximetry: the effect of fetal oxygen saturation below 30% on perinatal outcome. Eur J Obstet Gynecol Reprod Biol 2008; 136 (02) 160-164
- 11 Nonnenmacher A, Hopp H, Dudenhausen J. Predictive value of pulse oximetry for the development of fetal acidosis. J Perinat Med 2010; 38 (01) 83-86
- 12 Yeomans ER, Hauth JC, Gilstrap III LC, Strickland DM. Umbilical cord pH, PCO2, and bicarbonate following uncomplicated term vaginal deliveries. Am J Obstet Gynecol 1985; 151 (06) 798-800
- 13 Arikan GM, Scholz HS, Petru E, Haeusler MC, Haas J, Weiss PA. Cord blood oxygen saturation in vigorous infants at birth: what is normal?. BJOG 2000; 107 (08) 987-994
- 14 Raghuraman N, Temming LA, Stout MJ, Macones GA, Cahill AG, Tuuli MG. Intrauterine hyperoxemia and risk of neonatal morbidity. Obstet Gynecol 2017; 129 (04) 676-682
- 15 Westgate J, Garibaldi JM, Greene KR. Umbilical cord blood gas analysis at delivery: a time for quality data. Br J Obstet Gynaecol 1994; 101 (12) 1054-1063
- 16 Tuuli MG, Stout MJ, Macones GA, Cahill AG. Umbilical cord venous lactate for predicting arterial lactic acidemia and neonatal morbidity at term. Obstet Gynecol 2016; 127 (04) 674-680
- 17 Fanaroff AA. Meconium aspiration syndrome: historical aspects. J Perinatol 2008; 28 (Suppl. 03) S3-S7
- 18 Shankaran S, Laptook AR, Ehrenkranz RA. , et al; National Institute of Child Health and Human Development Neonatal Research Network. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353 (15) 1574-1584
- 19 Srinivasakumar P, Zempel J, Wallendorf M, Lawrence R, Inder T, Mathur A. Therapeutic hypothermia in neonatal hypoxic ischemic encephalopathy: electrographic seizures and magnetic resonance imaging evidence of injury. J Pediatr 2013; 163 (02) 465-470
- 20 Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR, Greene MF. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice, 7th ed. Philadelphia, PA: Elsevier/Saunders; 2014
- 21 Loscalzo J. Hypoxia and cyanosis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. , eds. Harrison's Principles of Internal Medicine, 18 ed. Chap. 35. New York, NY: The McGraw-Hill Companies; 2012
- 22 Westgren M, Divon M, Horal M. , et al. Routine measurements of umbilical artery lactate levels in the prediction of perinatal outcome. Am J Obstet Gynecol 1995; 173 (05) 1416-1422
- 23 Gorenberg DM, Pattillo C, Hendi P, Rumney PJ, Garite TJ. Fetal pulse oximetry: correlation between oxygen desaturation, duration, and frequency and neonatal outcomes. Am J Obstet Gynecol 2003; 189 (01) 136-138
- 24 Kühnert M, Seelbach-Göebel B, Butterwegge M. Predictive agreement between the fetal arterial oxygen saturation and fetal scalp pH: results of the German multicenter study. Am J Obstet Gynecol 1998; 178 (02) 330-335
- 25 Seelbach-Göbel B, Heupel M, Kühnert M, Butterwegge M. The prediction of fetal acidosis by means of intrapartum fetal pulse oximetry. Am J Obstet Gynecol 1999; 180 (1 Pt 1): 73-81
- 26 Althabe Jr O, Schwarcz RL, Pose SV, Escarcena L, Caldeyro-Barcia R. Effects on fetal heart rate and fetal pO2 of oxygen administration to the mother. Am J Obstet Gynecol 1967; 98 (06) 858-870
- 27 Khaw KS, Wang CC, Ngan Kee WD, Pang CP, Rogers MS. Effects of high inspired oxygen fraction during elective caesarean section under spinal anaesthesia on maternal and fetal oxygenation and lipid peroxidation. Br J Anaesth 2002; 88 (01) 18-23