Relationship Between Umbilical Cord Gas Values and Neonatal Outcomes


Assess the relationship between the umbilical cord gas value and fetal delivery tolerance, as reflected by the Apgar score. We assume that there is a wide range of biological variability in fetal tolerance to metabolic acidemia. If it exists, this will weaken a basic hypothesis using electronic fetal heart rate (FHR) monitoring. We conducted a retrospective cohort study of single, non-abnormal term fetuses born at our institution from March 2012 to July 2020. The commonly obtained umbilical cord gas value and Apgar score were extracted. We calculated Spearman's correlation coefficients and receptor operating characteristic curves for different umbilical artery pH levels, excess alkali, and Apgar score. We analyzed data from 29,787 deliveries. In all subgroups of the pH range (range 0.064-0.213), the statistical correlation between umbilical artery pH and alkali overdose and Apgar score between 1 minute and 5 minutes was weak or non-existent. The analysis of the receptor operating characteristic curve shows that the pH of the umbilical artery 7.22 has the best discrimination in predicting severe depression of newborns (Apgar score is less than 4 at 5 minutes), but the sensitivity and specificity of the predictive value are still relatively high. Poor to medium The use of electronic FHR monitoring is based on the recorded relationship between the FHR mode and the pH value of the umbilical artery, as well as the assumed correlation between the pH value and the fetal outcome, reflecting the fetus's tolerance to labor and delivery. Our data indicate that the correlation between metabolic acidemia and even short-term fetal conditions is weak or non-existent, which significantly weakens the latter hypothesis. Considering this flaw in the basic assumptions based on FHR monitoring, no future changes to the interpretation of the FHR model to better predict neonatal pH may lead to better neonatal outcomes.

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