The Association of Fetal Acidemia With Adverse Neonatal Outcomes at Time of Scheduled Cesarean Delivery

• DOI: 10.1097/01.ogx.0000918608.16972.a2
• Publication Date: 2023-03-01T15:02:53Z
• Authors: Katherine H. Bligard; Tamara Cameo; Kaitlin N. McCallum; Alexandra Rubin; Rebecca R. Rimsza; Alison G. Cahill; Arvind Palanisamy; Anthony O. Odibo; Nandini Raghuraman
• Keywords: Rupture of membranes; Umbilical artery

ABSTRACT Up to 30% of term labor deliveries experience fetal acidemia, a condition usually caused by hypoxia that is associated with adverse neonatal outcomes. The American College Obstetricians and Gynecologists Academy Pediatrics recommend assessing umbilical artery (UA) blood gases at delivery when metabolic status in question. Although UA pH 7.24 7.28 considered normal, the degree acidemia death unclear. Recent data suggest mild (UA 7.0–7.2) certain types (metabolic, mixed, or respiratory) also indicate increased risk for Most cases follow placental gas exchange interrupted during contractions. But rare scheduled prelabor cesarean (CD) not well described literature. This study aims determine if time scheduled, CD morbidity. was retrospective cohort comparing patients without defined as <7.2. Included were singleton neonates delivered via single tertiary care center from June 2004 December 2014. Excluded those who before 37 weeks gestation, diagnosed major anomalies, underwent due labor, rupture membranes, nonreassuring status. Also excluded which on validated cord unavailable. primary outcome composite outcomes, including death, encephalopathy, therapeutic hypothermia, seizures, intubation, respiratory distress. A total 2081 met inclusion criteria, present 252 (12.1%). Acidemia occurred more frequently breech born mothers gestational diabetes mellitus obesity. Intraoperative maternal hypotension, use vasopressor therapy, times anesthesia induction skin incision likely occur acidemia. observed 176 (8.5%) neonates. significantly higher than (7.6% vs 15.1%; adjusted ratio [aRR], 2.95; 95% confidence interval [CI], 2.03 4.12). Intubation (aRR 3.50; CI, 1.27–9.13) distress (aRR, 2.93; 2.00–4.13) among As rate categories decreased, proportion increased: 13.5% morbidity 7.0 7.19 versus 42.9% <7.0. Compared ≥7.2, outcomes rose 3.2-fold <7.1 3.23; 1.73–5.24) 6.6-fold <7.0 6.64; 3.23–8.96). 24.7% 27.5% 25% other There no after controlling confounders 2.7-fold (adjusted odds ratio, 2.77; 1.74–4.15) 3-fold mixed 3.08; 1.72–4.93). In conclusion, there an CD. this attributed