Umbilical Arterial pH < 7.00 in Newborns Delivered by Nonelective Cesarean Delivery: Risk Factors and Peripartum Outcomes

The objective of this study was to compare the risk factors and peripartum outcomes among patients who had nonelective cesarean delivery with umbilical arterial pH < versus ≥ 7.00. A case-control study of parturients who delivered by nonelective cesarean delivery and had a neonate with a pH < 7.00 were compared with the next four patients who delivered abdominally but had a newborn with a normal pH. Among 45 newborns with pH < 7.00 the rate of cesarean delivery for nonreassuring fetal heart rate was significantly more common in the case (56%) than control group (16%). The rates of end organ failure and neonatal death were similar for both groups. Although newborns with pH < 7.00 were significantly more likely to have cesarean delivery for nonreassuring fetal heart rate patterns and be admitted to the neonatal intensive care unit, there was no means to identify these patients until the abnormalities in tracing developed.

KEYWORDS

Umbilical arterial pH < 7.00 - cesarean delivery - nonreassuring fetal heart tracing

REFERENCES

• 1 Goldaber K G, Gilstrap L C, Leveno K J, Dax J S, MsIntire D D. Pathologic fetal acidemia.  Obstet Gynecol. 1991;  78 1103-1107
• 2 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;  162 1506-1512
• 3 Nagel H TC, Vandenbussche F PHA, Oepkes D, Jennekens-Schinkel A, Laan A EM, Gravenhorst J B. Follow-up of children born with an umbilical arterial blood pH < 7.  Am J Obstet Gynecol. 1995;  173 1758-1764
• 4 Van den Berg P P, Nelen W LDM, Jongsma H W et al.. Neonatal complications in newborns with an umbilical artery pH < 7.00.  Am J Obstet Gynecol. 1996;  175 1152-1157
• 5 Sehdev H M, Stamilio D M, Macones G A, Graham E, Morgan M A. Predictive factors for neonatal morbidity in neonates with an umbilical arterial cord pH less than 7.00.  Am J Obstet Gynecol. 1997;  177 1030-1034
• 6 Andres R L, Saade G, Gilstrap L C et al.. Association between umbilical blood gas parameters and neonatal morbidity and death in neonates with pathologic fetal acidemia.  Am J Obstet Gynecol. 1999;  181 867-871
• 7 American College of Obstetricians and Gynecologists .Fetal heart rate patterns: monitoring, interpretation, and management. ACOG Technical Bulletin Washington, DC; ACOG 1995
• 8 Herbst A, Wolner-Hanssen P, Ingemarsson I. Risk factors for acidemia at birth.  Obstet Gynecol. 1997;  90 125-130
• 9 Chauhan S P, Hendrix N W, Morrison J C, Magann E F, Devoe L D. Intrapartum oligohydramnios does not predict adverse peripartum outcome among high-risk parturients.  Am J Obstet Gynecol. 1997;  176 1130-1138
• 10 American College of Obstetrics and Gynecologists: Antenatal corticosteroid therapy for fetal maturation .ACOG Committee Opinion 210. Washington, DC; ACOG 1998
• 11 Murphy S L. Deaths: final data for 1998.  Natl Vital Stat Rep. 2000;  48 1-101
• 12 Williams K P, Singh A. The correlation of seizures in newborn infants with significant acidosis at birth with umbilical artery cord gas values.  Obstet Gynecol. 2002;  100 557-560
• 13 Barrett J FR, Jarvis G J, Macdonald H N, Buchan P C, Tyrrell S N, Lilford R J. Inconsistencies in clinical decisions in obstetrics.  Lancet. 1990;  336 549-551