Citation Information :
Srinivasan B, Pragna K. Comparison of Umbilical Arterial and Venous Lactate and Base Excess Values and Its Neonatal Outcome in High-risk Pregnancies. J South Asian Feder Obs Gynae 2021; 13 (5):301-305.
Aim and objective: The aim and objective of the study was to compare the paired umbilical arterial and umbilical venous blood gas analysis and its neonatal outcome in high-risk pregnancies at a risk of perinatal asphyxia.
Materials and methods: A 10–20 cm segment of umbilical cord was doubly clamped above the previous clamp immediately after delivery. Both the samples were sent for analysis immediately not exceeding 15 minutes. Blood gas analysis was done by ABG analyzer. Results were collected and compared. APGAR at 1 and 5 minutes of the neonate was noted.
Results: Sensitivity for APGAR at 5 minutes obtained for a mean value of 4.5 mmol/L for arterial lactate was 94% and the specificity was 32%. For a base excess mean value of −10 mmol/L in the arterial sample, sensitivity was 81% and specificity was 32% observed for APGAR. When lactate was compared to arterial base excess, the area under the receiver operating characteristic (ROC) curve was higher for base excess.
Conclusion: Comparison of paired cord blood gas analysis of pH, lactate, and base excess is a valuable adjunct to guide the management of newborns in high-risk pregnancies. In our study, umbilical arterial sample was superior to venous sample in predicting neonatal outcome.
Clinical significance: Paired umbilical gas analysis is an effective method of practice for predicting neonatal acidemia in high-risk pregnancies. Both lactate and base excess had a high negative predictive value for predicting birth asphyxia that will work as an obstetric quality measure as well as an audit tool.
Executive Committee of the Society of Obstetricians and Gynecologists of Canada. Attendance at labour and delivery: guidelines for obstetrical care. SOGC Policy Statement No. 89, May 2000. J Soc Obstet Gynaecol Can 2000;22:389–391 [Accessed online from 2007].
Perlman JM. Intrapartum hypoxic-ischemic cerebral injury and subsequent cerebral palsy: medicolegal issues. Pediatrics 1997;99(6):851–859. DOI: 10.1542/peds.99.6.851.
Cantu J, Szychowski JM, Li X, et al. Predicting fetal acidemia using umbilical venous cord gas parameters. Obstet Gynecol 2014;124(5):926. DOI: 10.1097/AOG.0000000000000517.
Tuuli MG, Stout MJ, Shanks A, et al. Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term. Obstet Gynecol 2014;124(4):756. DOI: 10.1097/AOG.0000000000000466.
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. DOI: 10.1136/bmj.c1471.
Ullrich JR, Ackerman BD. Changes in umbilical artery blood gas values with the onset of respiration. Biol Neonate 1972;20(5):466–474. DOI: 10.1159/000240488.
Armstrong L, Stenson B. Effect of delayed sampling on umbilical cord arterial and venous lactate and blood gases in clamped and unclamped vessels. Arch Dis Child Fetal Neonatal Ed 2006;91(5):F342–F345. DOI: 10.1136/adc.2005.086744.
Sykes GS, Molloy PM. Effect of delays in collection or analysis on the results of umbilical cord blood measurements. Br J Obstet Gynaecol 1984;91(10):989–992. DOI: 10.1111/j.1471-0528.1984.tb03676.x.
Hilger JS, Holzman IR, Brown DR. Sequential changes in placental blood gases and pH during the hour following delivery. J Reprod Med 1981;26(6):305–307. PMID: 17951550.
Wiberg N, Källén K, Oloffson P. Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations. BJOG 2008;115(6):697. DOI: 10.1111/j.1471-0528.2008.01708.x.
Low JA, Pancham SR, Piercy WN, et al. Intrapartum fetal asphyxia: clinical characteristics, diagnosis, and significance in relation to pattern of development. Am J Obstet Gynecol 1977;129(8):857–872. DOI: 10.1016/0002-9378(77)90519-1.
Adam AP, Hahn CEW. In: Principles and practice of blood-gas analysis. 2nd ed. Edinburgh Landon, Melbourne and New York: Churchil Livingstone; 1982. p. 64.
Burnett RW, Covington AK, Fogh-Anderson N, et al. International Federation of Clinical Chemistry (IFCC). Scientific division committee on pH, blood gases and electrolytes. Approved IFCC recommendations on whole blood sampling, transport and storage for simultaneous determination of pH, blood gases and electrolytes. Eur J Clin Chem Clin Biochem 1995;33(4):247–253. PMID: 27891333.
Chou YH, Tsou Yau KI, Wang PJ. Clinical application of the measurement of cord plasma lactate and pyruvate in the assessment of high-risk neonates. Acta Paediatr 1998;87(7):764–768. DOI: 10.1111/j.1651-2227.1998.tb01744.x.
Low JA, Lindsay BG, Derrick EJ. Threshold of metabolic acidosis associated with newborn complications. Am J Obstet Gynecol 1997;177(6):1391–1394. DOI: 10.1016/s0002-9378(97)70080-2.
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. DOI: 10.1111/j.1471-0528.1994.tb13581.x.
Allanson ER, Waqar T, White C, et al. Umbilical lactate as a measure of acidosis and predictor of neonatal risk: a systematic review. BJOG 2017;124(4):584–594. DOI: 10.1111/1471-0528.14306.
Goodwin TM, Belai I, Hernandez P, et al. Asphyxial complications in the term newborn with severe umbilical acidemia. Am J Obstet Gynecol 1992;167(6):1506–1512. DOI: 10.1016/0002-9378(92)91728-s.