Umbilical cord ABG and perinatal outcome

Assessment of the acid-base status of umbilical cord blood at birth provides an

objective measure of the fetal response to labour and was recommended in 1993
by the 26th Study Group on Intrapartum Fetal Surveillance of the Royal College
of Obstetricians and Gynaecologists(RCOG).

An international consensus statement in 1999 also regarded this as an essential

requirement for assessing the outcome of labour.

In May 2001 the Royal College of Obstetricians and Gynaecologists Evidence-

based Clinical Guideline No. 8 on The Use of Electronic Fetal Monitoring has
recommended that umbilical artery acid-base status be used as anintermediate
outcome measure of fetal hypoxia in all hospitals.

These recommendations have been endorsed by the National Institute for Clinical
Excellence. (NICE)
Umbilical cord blood gas and acid-base assessment are the
most objective determinations of the fetal metabolic
condition at the moment of birth.
Moderate and severe newborn encephalopathy, respiratory complications, and composite
complication scores increase with an umbilical arterial base deficit of 12-16 mmol/L.

Moderate or severe newborn complications occur in 10% of neonates who have this level
of acidemia and the rate increases to 40% in neonates who have an umbilical arterial base
deficit greater than 16 mmol/L at birth.

Immediately after the delivery of the neonate, a segment of umbilical cord should be
double-clamped, divided, and placed on the delivery table.

Physicians should attempt to obtain venous and arterial blood cord samples in
circumstances of cesarean delivery for fetal compromise, low 5-minute Apgar score,
severe growth restriction, abnormal fetal heart rate tracing, maternal thyroid disease,
intrapartum fever, or multifetal gestation.

Prematurity Risk Evaluation Measure or PREM score

Its based on gestation, birthweight for gestation, and base deficit from umbilical cord
blood.

Results:

Gestation was by far the most powerful predictor of survival to term, and as few as five
extra days can double the chance of survival.
Weight for gestation also had a powerful but non-linear effect on survival, with weight
between the median and 85th centile predicting the highest survival.

Using this information survival can be predicted almost as accurately before birth as
after, although base deficit further improves the prediction.

A simple graph is described that shows how the two main variables gestation and weight
for gestation interact to predict the chance of survival.

Conclusion: The PREM score can be used to predict the chance of survival at or before
birth almost as accurately as existing measures influenced by post-delivery condition; to
balance risk at entry into a controlled trial; and to adjust for differences in ‘case mix’
when assessing the quality of perinatal care.