DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20195185

Relation between immediate postpartum APGAR score with umblical cord blood pH and fetal distress

Varuna Pathak, Deep Shikha Sahu

Abstract


Background: The one-minute Apgar score, proven useful for rapid assessment of the neonate, is often poorly correlated with other indicators of intrauterine well-being. Fetal asphyxia is directly associated with neonatal acidosis. Umbilical cord pH is best indicator of fetal hypoxemia and hypoxemia leads to neonatal acidosis. In today scenario, fetal distress is the leading indication of emergency cesarean section.

Methods: A observational cross-sectional study conducted of one year between march 2017 to February 2018; of full-term obstetric patients undergoing emergency cesarean section for fetal distress as an indication. All patients included are term gestation with low risk pregnancy excluding medical disorders and other complications of pregnancy. Immediately after delivery umbilical artertial cord blood from placental site collected and sent for pH determination and Apgar score calculated of newborn.

Results: Emergency cesarean section was being done for fetal distress diagnosed based on guidelines for Intermittent auscultation; maximum patients had fetal bradycardia (240) followed by fetal tachycardia (12) and irregular rhythm (18). Relation between pH value and the fetal outcome babies who had low pH value. i.e. <7.1; had maximum referrals with poor Apgar score at 1 min (<3) and at 5 min (<3). Out of 270 babies 18 had Apgar score <3 at 1 min, out of which 10 continued to have Apgar score <3 at 5 mins. These babies were referred to department of pediatrics and were not alive beyond day 2-4.

Conclusions: The values of mean Apgar score and cord blood pH decreases, which is inversely proportion to duration and severity of intrauterine/intra partum asphyxia. Umbilical arterial cord blood pH correlation was found to be significant with Apgar score in neonates delivered with indication as fetal distress.


Keywords


Apgar score, Cesarean section, Fetal distress, Umbilical cord blood pH

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References


Tasnim N, Mahmud G, Akram S. Predictive accuracy of intrapartum cardiotocography in terms of fetal acid base status at birth. J Coll Physicians Surg Pak. 2009;19(10):632-5.

Malin GL, Morris RK, Kha KS. Strength of association between umbilical cord pH and perinatal and long-term outcomes: systematic review and metaanalysis. BMJ. 2010;340:c1471.

Parveen S. Umbilical cord arterial blood base excess as gold standard for foetal well-being screening test validity at term delivery. J Pak Med Assoc. 2010;60(5):347-50.

American College of Obstetricians and Gynecologists. Practice bulletin no. 116: management of intrapartum fetal heart rate tracings. Obstet Gynecol. 2010;116(5):1232-40.

Lyndon A, Ali LU, eds. Fetal heart monitoring principles and practices. 4th ed. Dubuque, IA: Kendall-Hunt Publishing Company; 2009.

Liston R, Sawchuck D, Young D. Society of obstetrics and gynaecologists of Canada, British Columbia Perinatal Health Program. Fetal health surveillance: antepartum and intrapartum consensus guideline. J Obstet Gynaecol Can. 2007;29(9 Suppl 4):S3-S56.

National Institute for Health and Care Excellence. Intrapartum care of healthy women and their babies during childbirth. Available at: http://www.nice.org.uk/guidance/cg55. Accessed on 11th November 2014.

Williams KP, Singh A. The correlation of seizures in newborn infants with significant acidosis at birth with umbilical artery cord gas values. Obstet Gynecol. 2002;100(3):557-60.

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;22:389-91.

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.

The report of ACOG’s task force on neonatal encephalopathy and cerebral palsy has been published. Neonatal Encephalopathy and Cerebral Palsy: Execut Sum Obstet Gynecol. 2004;103(4):780-1.

Tong S, Egan V, Griffin J, Wallace EM. Cord blood sampling at delivery: do we need to always collect from both vessels? BJOG. 2002;109(10):1175-7.

Perveen F, Khan A. Umbilical cord blood pH in intrapartum hypoxia. J College Phys Surg Pak. 2015;25(9):667-70.

Meena P, Meena M, Gunawat M. Correlation of APGAR score and cord blood pH with severity of birth asphyxia and short-term outcome. Int J Contemp Pediatr. 2017;4:1325-8.

Goldaber KG, Leveno KJ, Gilstrap LC, Dax JS, McIntire DD. Pathologic fetal acidemia. Obstet Gynecol. 1991;78(6):1103-7.