Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit
Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit
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DOI：
10.1111/j.1479-828x.2010.01192.x
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发表时间：
2010-08-01
影响因子：
1.7
通讯作者：
Pennell, Craig E.
中科院分区：
文献类型：
--
作者：
White, Christopher R. H.;Doherty, Dorota A.;Pennell, Craig E.
背景：目前的证据表明，脐动脉pH值分析提供了最敏感的反映出生窒息。然而，有争议是否脐带血气体分析（UC-BGA）应进行部分或所有delivers.Aim：本研究的目的是评估的影响，引入通用UC-BGA在交付对围产期outcome.Methods：一项观察性研究，所有交付>= 20周的妊娠在第三产科单位2003年1月至2006年12月。对97%的分娩（n = 19，646）进行了配对UC-BGA。单因素分析和校正分析评估了UC-BGA的年间差异以及代谢性酸中毒和婴儿入院的可能性。结果：在单因素分析和校正分析中，脐动脉pH、pO（2）、pCO（2）、碱过剩和乳酸值均呈进行性改善（P < 0.001）。动脉pH < 7.10（OR = 0.71; 95%CI 0.53-0.95）和乳酸> 6.1 mmol/L（OR = 0.37; 95%CI 0.30-0.46）的新生儿有显著降低。使用人群特异性第5和第95百分位数，动脉pH低于第5百分位数（pH 7.12; OR = 0.75; 95%CI 0.59-0.96）和乳酸水平高于第95百分位数（6.7 mmol/L; OR = 0.37; 95%CI 0.29-0.49）的新生儿减少。足月（OR = 0.65; 95%CI 0.54-0.78）和总体（OR = 0.75; 95%CI 0.64-0.87）托儿所入院率降低。这些改善围产期的结果是独立的干预rate.Conclusions：这些数据表明，引入通用UC-BGA可能会导致改善围产期的结果，这被观察到是独立的产科干预。我们认为，这些改善可能是由于提供的生化数据有关的胎儿酸碱状态在交付影响产后护理在随后的情况下。
Background:Current evidence suggests that umbilical arterial pH analysis provides the most sensitive reflection of birth asphyxia. However, there's debate whether umbilical cord blood gas analysis (UC-BGA) should be conducted on some or all deliveries.Aim:The aim of this study was to evaluate the impact of introducing universal UC-BGA at delivery on perinatal outcome.Methods:An observational study of all deliveries >= 20 weeks' gestation at a tertiary obstetric unit between January 2003 and December 2006. Paired UC-BGA was performed on 97% of deliveries (n = 19,646). Univariate and adjusted analysis assessed inter-year UC-BGA differences and the likelihood of metabolic acidosis and nursery admission.Results:There was a progressive improvement in umbilical artery pH, pO(2), pCO(2), base excess and lactate values in univariate and adjusted analyses (P < 0.001). There was a significant reduction in the newborns with an arterial pH < 7.10 (OR = 0.71; 95%CI 0.53-0.95) and lactate > 6.1 mmol/L (OR = 0.37; 95%CI 0.30-0.46). Utilising population specific 5th and 95th percentiles, there was a reduction in newborns with arterial pH less than 5th percentile (pH 7.12; OR = 0.75; 95%CI 0.59-0.96) and lactate levels greater than 95th percentile (6.7 mmol/L; OR = 0.37; 95%CI 0.29-0.49). There was a reduction in term (OR = 0.65; 95%CI 0.54-0.78), and overall (OR = 0.75; 95%CI 0.64-0.87) nursery admissions. These improved perinatal outcomes were independent of intervention rates.Conclusions:These data suggest that introduction of universal UC-BGA may result in improved perinatal outcomes, which were observed to be independent of obstetric intervention. We suggest that these improvements might be attributed to provision of biochemical data relating to fetal acid-base status at delivery influencing intrapartum care in subsequent cases.