Evaluation of the Relationship Between Fetal Distress and Ph of Umbilical Cord Artery of Neonates

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1 Middle-East Journal of Scientific Research 13 (1): 20-24, 2013 ISSN IDOSI Publications, 2013 DOI: /idosi.mejsr Evaluation of e Relationship Between Fetal Distress and Ph of Umbilical Cord Artery of Neonates Mojibian Mahdieh, Mostafavi Mahdieh and Karimi Mehran 1 Obstetrics and Gynecology Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2 Resident of Obstetrics and Gynecology, Obstetrics and Gynecology Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 3 Department of Pediatric, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Abstract: Decreasing fetal distress and possible side effects of it is a golden aim in obstetrics, so diagnosis of fetal distress is important in labour. Beside high value of Apgar score in diagnosis of fetal distress it is not precisely a predictive factor. In perinatal period fetal distress is defined by meconium in amniotic fluid and abnormal patterns of fetal heart monitoring. This study was designed to determine e relation between fetal distress and umbilical cord ph in neonates at bir. This study was performed on 400 pregnant women referred to shahid Sadughi and Mojibian Labour Hospital and did not have any disorders except DM, PIH and hypoyroidism. In bo case and control groups immediately after delivery one milliliter of umbilical cord artery was gaered by heparin syringe. Variables related to distress and demographic characteristics were gaered by a check list and analyzed by Chi-Square, Fisher Exact and T-Test. Mean ± SD of age in case and control group was 27.52±5.27 and 27.18±4.81, respectively. There was not a significant difference between groups. There was a significant difference between groups for first and 5 minutes APGAR scores. Acceleration and late deceleration were also related to fetal distress. In our survey, two neonates had ph less an 7.14 one between 7 to 7.2 and oer was more an 7.2. Mean ± SD of ph was 7.35±0.09 and 7.36±0.07 in case and control groups, respectively. According to our data, baseline disorders of moers including hypoyroidism, PIH, Overt DM and GDM had no relation wi fetal distress. Beside is we can concluded at ph, PCO2 and Base Deficit of umbilical cord are not a precise predictive factor for fetal distress. Key words: Fetal distress % Umbilical cord ph % APGAR INTRODUCTION 50 percent of results of CTG are not reliable and only a small part of ese fetuses are in hypoxic situation. Diagnosis of fetal distress rough labor is important. In ese cases anoer high specific diagnostic test is A simultaneous evaluation of fetal heart rate and uterine needed. External monitoring is not as efficient as CTG [5] contractions is e manner used in e world for fetal National collaborating center for women s and children s surveillance. Because of its low specificity is meod heal introduced e monitoring of fetus and neonate as has developed rates of surgical deliveries wiout a a manner of detecting hypoxemia and acidosis which can decrease in perinatal mortality [1]. play an important role in neurological sequels [6]. Alough e Cardiotogram(CTG) has a good In 1962, Saling et al. [7, 8] established a new way in sensitivity, ST-events happen at e similar frequency for detecting fetal distress due to hypoxia during labor in normal and abnormal CTG patterns. This shows e need which sampling of blood from fetus scalp has been used. for more efficient information for detecting fetal response The cord ph has been considered as a definitive to hypoxemia [2, 3]. Normal results in CTG show at e factor for fetus evaluation. Studies showed at low ph fetus is in an enough oxygen situation [4]. Approximately is significantly associated wi long- term adverse Corresponding Auor: Mostafavi Mahdieh, Resident of Obstetrics and Gynecology, Obstetrics and Gynecology Department, Shahid Sadoughi University of Medical Sciences-Yazd, Iran. 20

2 consequences, but e level of ph which is determined for clamped and blood sample of umbilical artery was cut off point is not clear [9]. Normal range of umbilical gaered in a heparin syringe. The sample was transmitted cord ph is 7.40±0.20. mixed and ph less an 7 is to e laboratory wiin 10 minutes by observing standard important because in is range probability of seizure, meods. mortality, intubation, NICU admission increases [10]. Weight of newborn was calculated in labor and There is a growing attitude for using umbilical cord Apgar scores were determined in 0 and 5 minutes after blood gas (UCBG) analysis on all deliveries to obtain an delivery. Oer variables including age of moer, objective indicator of neonatal status and predict even if gestational age, site of neonate admission and status of e fetus has been exposed to perinatal hypoxia [11] umbilical cord (eier compressed or not compressed) Hypoxemia activates e autonomic part of nervous were gaered and entered in a check list. system and it affects beat-to-beat heart rate [3]. All data were analyzed wi descriptive and analytic Decreasing fetal distress and fetal morbidity and tests of SPSS-11. mortality is a golden aim in obstetrics. Fetal distress may All e steps of is study were evaluated and be due to chronic hypoxia, mechanical trauma, confirmed by Research Committee of Shahid Sadughi hyperermia, sepsis and meconium aspiration. In labor Medical University and all patients took part in our study fetal distress has been diagnosed wi abnormal fetal after eical testimonial. monitoring or finding meconium in amniotic fluid. It is suggested at some cerebral damages in newborn RESULTS children are related to perinatal distresses [12]. Metabolic acidosis wi evidence of neonatal One of investigated women had vaginal bleeding and neurologic disorders like seizure, hypotonia, single or hypotension and wi diagnosis of rupture of uterine and multiple organ failure is depended on some situations had undergone cesarean and her neonate was expired. including: ph of umbilical cord less an 7 and APGAR Data of is neonate was omitted and analysis was done score less an 3, to mention e perinatal distress as a on 399 oer pregnant women and eir neonates. cause of cerebral damages [13]. The mean age of pregnant women in control group Nowadays it is confirmed at e role of labor in e was calculated as 27.52±5.27 years old while it was cerebral palsy have been limited and estimated up to 15% 27.18±4.81 in case group. Analytic evaluations wi of children [14]. There are many factors at take part in T-Test showed at ere was no significant developing cerebral encephalopay which most of em (P-Value$0.05) difference between two groups regarding happen before labor, but perinatal adventures in labor are age (Table 1). mentioned because wi suitable control of em risks of Mean gestational age in case group was ±2.16 cerebral damages decrease till 0.2 folded [15]. weeks and it was ±1.56 weeks in control group. This study was designed to evaluate e relation This difference was not significant (P-Value$0.05) between fetal distress and umbilical cord ph in neonates. between two groups (Table 1). st Mean Apgar score in 1 minute was 8.98 ±1.54 and MATERIALS AND METHODS 9.37 ±0.87 in case and control groups, respectively. This difference was significant between two groups In is study, 400 neonates referred to e shahid (P-Value=0.001). While mean Apgar score in 5 minute Sadoughi and Mojibian labor hospitals in Yazd, Iran was 9.67 ±0.82 and 9.84 ±0.60 in case and control group, were evaluated. Children were divided into two groups; respectively and is difference was significant between distress or not distress. Fetus abnormal Non Stress Test groups (P-Value=0.043) (Table 1). (NST) or Meconium in his amniotic fluid were considered Mean weight of neonates was ± gm in as stress. case group and ± gm in control group and Women wi medical diseases have been excluded ere was no significant (P-Value$0.05) difference from our study except Hypoyroidism, pregnancy between groups (Table 1). induced hypertension and gestational Diabetes mellitus. In is study, in 51 cases (12.8%) meconium was In bo groups immediately after delivery observed in amniotic fluid and 189 ones (47.3%) needed (eier vaginal delivery or Cesarean) umbilical cord was re-monitoring. 21

3 Table 1: Comparison of moer age, gestational age, Apgar score and bir weight in case and control groups Case group Control group Total Variable N Mean SD N Mean SD N Mean SD P-Value Moer age Gestational age APGAR(0) APGAR(5) Bir weight Table 2:Comparison of ph, PCO2 and base deficit in case and control groups Case group Control group Total Variable N Mean SD N Mean SD N Mean SD P-Value PH PCO Base Deficit PCO2: carbon dioxide partial pressure Base Deficit: A decrease in e total concentration of bicarbonate indicative of metabolic acidosis or of compensated respiratory alkalosis. The Number Of case and control groups was changeable, because is study was case control and in all documents we could not find all data In control group, 310 women who did not have Wi following of neonates 70.8 and 85.6% of women meconium in eir amniotic fluid or eir fetus did not in case and control group respectively were admitted after have abnormal NST, ere was 8 women (2.6%) wi overt bir in NICU ward. Chi-Square test which was done diabetes mellitus while ere was no report of is disorder showed at ere is a significant difference between in case group,89 women who had meconium in eir groups (P-Value=0.001). amniotic fluid or abnormal NST in eir fetus. Fisher Exact In is survey, 2 neonates had ph lower an 7, 14 Test showed at ere is not a significant (P-Value$0.05) ones between 7 to 7.2 and oers had ph more an 7.2. difference between groups (P-Value=0.208) and about Mean ± SD of ph was determined to be 7.35±0.09 in gestational diabetes mellitus also results showed at case control while is was 7.36±0.07 in control group ere is not significant (P-Value$0.05) difference between and is difference was not significant (P-Value$0.05) groups. (Table 2). In is evaluation, 5 women (5.6%) among 89 women Comparison of groups about e relationship in case group and 13 ones (4.2%) in control group had between bir weight, medical disease of moers and pregnancy induced hypertension. Hypoyroidism was acidosis showed at ere was not a significant reported as 9 and 10% in case and control groups (P-Value$0.05) relation between ese factors and respectively. Analytic tests showed at ere is no acidosis. significant difference (P-Value$0.05) between groups. Comparison between pattern of fetal heart Fetal heart monitoring showed acceleration in monitoring and acidosis showed at ere was no 58.4 and 83.5% in case and control group, respectively. significant (P-Value$0.05) relation between em. This difference was significant (P-Value=0.001). Early deceleration was also mentioned which was not DISCUSSION significantly (P-Value$0.05) different between two groups, but late deceleration was reported in two women This study was performed on 399 pregnant women in case group against no report of it in control group. who were admitted to shahid Sadughi and Mojibian labor This difference was a significant one (P-Value=0.049). Hospitals of Yazd, Iran between January 2012 and About delivery type in our study, 23.6% women in September case group delivered by NVD while is proportion was Mean ± SD of age between case and control group 40% in control group and ere was a significant wasn t significantly (P-Value$0.05) different. This means difference between groups (P-Value=0.005). at population of study was divided into case and Situation of umbilical cord was evaluated and free control group equally. About gestational age between umbilical cord was reported in 76.4% of neonates in case case and control group ere was no significant difference group while is situation was 80.9% in control ones. (P-Value$0.05). 22

4 Mean ± SD of APGAR scores in first and 5 minutes at PH, PCO2 and Base Deficit of umbilical cord are not had significant difference (P-Value#0.05). These scores a precise predictive factor for fetal distress. In our survey, were less in case group an control group and e results ere was a significant difference between groups in first agree wi Lotfalizadeh et al. [16] who reported at case and 5 minutes Apgar score. Bir weight of neonates was group is high risk women who are diagnosed by positive not a diagnostic factor for predicting perinatal fetal Biophysical Profile or OCT or non-reactive Non Stress distress. Test (NST). Ahmadpour et al. [17] designed a prospective study in Babol, Iran in which pregnant women are divided REFERENCES into high and low risk groups according to risk factors of pregnancy. Van Laar et al. [11] in e Neerlands 1. Abeer Eswi and Amal Khalil, Prenatal compared between neonates wi and wiout acidosis. Attachment and Fetal Heal Locus of Control among In Wiberg-Itzel study [7] which was done in Sweden also Low Risk and High Risk Pregnant Women. World ere was not significant different (P-Value$0.05) between Applied Sciences Journal, 18(4): high and low risk groups. 2. Pourjafar, M., K. Badiei, A.A. Chalmeh, A.R. Sanati, In our study, ere were no significant differences M.H. Bagheri, M. Badkobeh and A. Shahbazi, (P-Value$0.05) between Gestational Diabetes Mellitus Cardiac Arrhymias in Clinically Healy (GDM), Overt Diabetes Mellitus, Hypoyroidism and Newborn Iranian Fat-Tailed Lambs. Global Pregnancy Induced Hypertension (PIH) incidence. Veterinaria, 6(2): This means at according to is study ese disorders 3. Ravenswaaij-Arts, C.M., L.A. Kollée, J.C. Hopman, were not e causes of fetal distress. Our results are G.B. Stoelinga and H.P. Van Geijn, Heart rate against some oer studies like a survey which was done variability. Ann Intern Med., 118(6): Review. on 440 pregnant women in Saudi Arabia. Sahu et al. [18] 4. Vintzileos, A.M., D.J. Nochimson, A. Antsaklis, investigated 633 pregnant women in India and concluded I. Varvarigos, E.R. Guzman and R.A. Knuppel, at hypoyroidism is able to cause fetal abnormal Comparison of intrapartum electronic fetal heart rate growing and distress of neonates at bir. Spinato et al. monitoring versus intermittent auscultation in [19] also performed a study in which PIH was determined detecting fetal acidemia at bir. Am. J. Obstet. as one of e risk factors of fetal distress. Gynecol., 173(4): According to patterns of fetal heart monitoring, 5. Ingemarsson, I., E. Ingemarsson and J.A.D. Spencer, acceleration and late deceleration were significantly more Fetal heart rate monitoring. A practical guide. in case group. These results are similar to Martin et al. Oxford: Oxford University press. [20] in France. 6. National collaborating center for womens and In is study ere was a significant difference childrens heal.intrapartum care, Care of between groups for NICU admission. healy women and eir babies during childbir. Mean ± SD of PH, PCO2 and Base Deficit was not clinical guideline. London: RCOG press. significantly different between groups. There was a 7. Wiberg-Itzel, E., C. Lipponer, M. Norman, A. Herbst, controversy between studies. Rafati et al. [21] found at D. Prebensen and A. Hansson, Determination ere is no relation between type of delivery (NVD or of ph or lactate in fetal scalp blood in management of Cesarean) and umbilical cord blood gas [21]. Ahmadpour intrapartum fetal distress: randomized controlled et al. [17] reported at ere is not a significant relation multicentre trial. BMJ, 336(7656): between APGAR scores in first and 5 minutes and 8. Saling, E., Fetal scalp blood analysis. J Perinat arterial ph of umbilical cord. Kaveh et al. [22] concluded Med., 9(4): at arterial ph of neonates at bir are significantly 9. Malin, G.L., R.K. Morris and K.S. Khan, different between high risk and low risk group. Streng of association between umbilical cord Lotfalizadeh et al. [16] concluded at ere is a ph and perinatal and long term outcomes: significant relation between NST test and acidosis. systematic review and meta-analysis. BMJ., There was also a relation between Biophysical Profile and 340:c1471. Review. acidosis in Valadan et al. study [23]. 10. Ghosh, B., S. Mittal, S. Kumar and V. Dadhwal, According to our data, baseline disorders of moers Prediction of perinatal asphyxia wi nucleated red including hypoyroidism, PIH, Overt DM and GDM has blood cells in cord blood of newborns. Int. J. not relation wi fetal distress. Beside is we concluded Gynaecol. Obstet., 81(3):

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