Yıl: 2002 Cilt: 33 Sayı: 4 Sayfa Aralığı: 236 - 244 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi

Öz:
Umbilikal kordon pH ve gaz değerleri yük¬sek riskli doğumlarda ve düşük apgar skorlu yenidoğanlarda düşünülmeli ve öncelikle UA pH alınmalıdır. Böylelikle gerçek hipoksemik ve asidemik bebekler ayrılmış olacaktır. Bu sayede böyle bebeklere klinik yardım ve yak¬laşımın doğru , yeterli ve öncelikli olarak uy¬gulanması sağlanacaktır. Aynı zamanda düşük apgar skorlu doğan bebeklerde gerçek doğum asflksi tanısı %80 dışlanabilecektir. Bu sonuç¬lar doğrultusnda, ACOG (American College of Obstetrics and Gynecologists )önerisine paralel olarak, her yenidoğanda olmasa bile, riskli ge¬beliklerde, özellikle antepartum fetal asfîksi saptanan ve intrapartum fetal distres belirlenen vakalarda umbilikal kordon kan gazları tetkik¬lerinin, neonatal yardım ve girişimlerin doğru ve zamanında yapılması bakımından faydalı olacağı görüşüne varılmıştır.
Anahtar Kelime: Fetal distres Fetal kan Göbek bağı Kan gazı analizi Asidoz Asfiksi Gebelik, yüksek riskli

Konular: Genel ve Dahili Tıp

Analysis of umbilical cord blood acid-base status at birth

Öz:
Background and Design.- Analysis of umbilical cord blood acid-base status at birth could give some information about the fetal intrapartal condition retrospectively. Normally umbilical cord arterial blood reflects fetal acid-base balance and umbilical cord venous blood reflects a combination of maternal acid-base status and placental function. In this study we aimed to demonstrate the relationship between the umbilical cord gas parameters and fetal well-being as well as to assess the usefulness of routine umbilical cord blood sampling. During a 12-month period we made the umbilical cord arterial and venous blood gas analysis of 199 healthy pregnant women between the 37th and 42nd week of gestation. During the trial all samples were taken by the same trained midewife and nurse. Immediately after each birth, the umbilical cord was clamped twice about 10 cm apart.Blood was taken first from the artery and from the vein using preheparinised syringes. Analysis was achieved within 30 minutes of delivery. Tracings indicative of fetal acidosis were defined as persistent late decelerations and severe variable decelerations (heart rate dropping to <70 beats/min and lasting >60 seconds). Results.- We classified the deliveries as normal (head or breech presentation with or without induction) and operative (Cesarean section, vacuum and forceps deliveries) to compare the fetal blood parameters. Each group was evaluated for the existence of intra-uterine growth retardation and fetal weight at delivery separately. Umbilical cord arterial pH, PO2 and venous pH, pCO2, pO2 difference between normal deliveries and operative deliveries done for fetal distress were statistically significant (p<0.05). Conclusion.- We conclude that umbilical cord blood pH and gases should be obtained only in cases of high risk pregnancies and in depressed newborns so that the diagnosis of neonatal asphyxia could be excluded in 80% of the cases.
Anahtar Kelime: Acidosis Asphyxia Pregnancy, High-Risk Fetal Distress Fetal Blood Umbilical Cord Blood Gas Analysis

Konular: Genel ve Dahili Tıp
Belge Türü: Makale Makale Türü: Diğer Erişim Türü: Erişime Açık
  • 1. Goldaber KG, Gilstrap LC. Correlations between clinical events and umbilical cord blood acid-base and blood gas values. Clin Obstet Gynecol 1993;36:47-59 2. Royal College of Obstetricians and Gyaecologists. intrapartum Fetal Surveillance in Spencer J.A.D, Ward R.H.T (eds), London, RCOG Press, 1993, 392 3. Dennis J, Johnston A. Mutch L, Yudkin P, Johnston P. Acid-base status at birth and neurodevelopment outcome at four and one-half years. Am J Obstet Gynecol 1989;161:213-220 4. Page FO,Martin JN, Palmer SM, Martin RW, Lucas JA, Meeks GR, Bucovaz ET, Morrison JC. Correlation of neonatal acid-base status with Apgar scores and fetal heart rate tracings. Am J Obstet Gynecol 1986; 154:1306-11 5. American Academy of Pediatrics. Use and abuse of the Apgar score. Pediatrics 1996; 98 (1) :141-2. Kubli FW, Hon EH, Khazin AF, Tkemura H. Observations on heart rate and pH in the human fetus during labor. Am Obstet Gynecol 1969; 104(8): 1190-206. 7. Yeomans ER,Hauth JC, Gilstrap LC, Strickland DM. Umbilical cord pH, PCO2 and bicarbonate following uncomplicated term vaginal deliveries. Am J Obstet Gynecol 1985;151:798-800 8. Gilstrap LC, Hauth JC,Toussaint S. Second stage fetal heart abnormalities and neonatal acidosis. Obstet Gynecol 1984;63:209-13 9. Gilstrap LC, Hauth JC, Schiano S, Connor KD. Neonatal acidosis and method of delivery. Obstet Gynecol 1984; 63:681-5. 10. Paul RH, Suidan AK, Yeh S, Schifrin BS, Hon EH. Clinical fetal monitoring.VII. The evaluation and significance of intrapartum baseline FHR variability. Am j Obstet Gynecol 1975; 123: 206-10. 11. Wible JL,Petrie RH,Koons A, Perez A. The clinical use of umbilical cord acid-base determinations in perinatal surveillance and management. Clin Perinatoll982;9:387- 97 12. Gilstrap LC. Fetal acid-base balance. In R.K Creasy and R. Resnik, (eds.), Maternal -Fetal Medicine ,ed 4.Philadelphia,WB Saunders, 1998;331 13. Fujikara T.Yoshida J. Blood gas analysis of placental and uterine blood during cesarean delivery. Obstet Gynecol 1996;87:133-6 14. Johnson JWC. Cord blood gas studies: a survey.Clin Obstet Gynecol 1993; 36, 99-101. 15. Gordon A, Johnson JWC. Value of umblical blood acid- base studies in fetal assessment. J Reprod Med 1985;30:329-36 16. Thorp JA, Rushing RS.Umbilical cord blood analysis. Clin Obstet Gynecol 1999;26(4):695-709 17. Thorp JA, Dildy GA, Yeomans ER, Meyer BA, Parisi VM. Umbilical cord blood gas analysis at delivery. Am J Obstet Gynecol 1996;175 (3):517-22 18. Atalla RK.Abram SK, Bell SC, Taylor DJ. Newborn acid-base status and umbilical cord morphology. Obstet Gynecol 1998;92:865-8 19. Ramin SM, Gilstrap LC, Levenok KJ, Bums J, Little B.Umbilical artery acid-base status in the preterm infant. Obstet Gynecol 1989;74:256-8
  • 20. Sykes GS, Molloy PM, Johnson P, Gu W, Ashworth F, Stirrat GM, Turnbull AC. Do Apgar scores indicate asphyxia? Lancet 1982; 1:494-6 21. Nickelsen C, Weber T. Acid base evaluation of umbilical cord blood : relation to delivery mode and Apgar scores. Eur J Obstet Gynecol Reprod Biol 1987;24(3): 153-65 22. Goldaber KG, Gilstrap LC 3rd; Leveno KJ, Dax JS. Pathologic fetal acidemia. Obstet Gynecol 1991 ;78(6): 1103-7 23. Thorp Ja, Boylan PC.Parisi VM, Heslin EP. Effects of high dose oxytocin augmentation on umbilical cord blood gas values in primigravid women. Am J Obstet Gynecol 1988;159:670-5 24. Lutherkort M, Marsal K. Umbilical cord acid-base state and Apgar score in term breech neonates. Acta obstet Gynecol Scand 1987;66: 57-60 25. Daniel Y, Fait G, Lessing JB, Jaffa A, Gull I, Shenav M, Peyser MR, Kupferminc MJ. Umbilical cord blood acid- base values in uncomplicated term vaginal breech deliveries. Acta Obstet Gynecol Scand 1998;77:182-5 26. Andres RL, Saade G, Gilstrap LC, Wilkins I, Witlin A, Zlatnik F, Hankins GV. Association between umbilical blood gas parameters and neonatal morbidity and death in neonates with pathologic fetal acidemia. Am J Obstet Gynecol 1999;181:867-71 27. Low JA, Lindsay BG, Derrick EJ. Threshold of metabolic acidosis associated with newborn complications. Am J Obstet Gynecol 1997;177 (6):1391-4
APA BENİAN A, ULUDAĞ S, ATIŞ A, Gök M, Madazli R (2002). Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi. , 236 - 244.
Chicago BENİAN Ali,ULUDAĞ Seyfettin,ATIŞ Alev,Gök Murat,Madazli Riza Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi. (2002): 236 - 244.
MLA BENİAN Ali,ULUDAĞ Seyfettin,ATIŞ Alev,Gök Murat,Madazli Riza Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi. , 2002, ss.236 - 244.
AMA BENİAN A,ULUDAĞ S,ATIŞ A,Gök M,Madazli R Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi. . 2002; 236 - 244.
Vancouver BENİAN A,ULUDAĞ S,ATIŞ A,Gök M,Madazli R Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi. . 2002; 236 - 244.
IEEE BENİAN A,ULUDAĞ S,ATIŞ A,Gök M,Madazli R "Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi." , ss.236 - 244, 2002.
ISNAD BENİAN, Ali vd. "Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi". (2002), 236-244.
APA BENİAN A, ULUDAĞ S, ATIŞ A, Gök M, Madazli R (2002). Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi. Cerrahpaşa Tıp Dergisi, 33(4), 236 - 244.
Chicago BENİAN Ali,ULUDAĞ Seyfettin,ATIŞ Alev,Gök Murat,Madazli Riza Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi. Cerrahpaşa Tıp Dergisi 33, no.4 (2002): 236 - 244.
MLA BENİAN Ali,ULUDAĞ Seyfettin,ATIŞ Alev,Gök Murat,Madazli Riza Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi. Cerrahpaşa Tıp Dergisi, vol.33, no.4, 2002, ss.236 - 244.
AMA BENİAN A,ULUDAĞ S,ATIŞ A,Gök M,Madazli R Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi. Cerrahpaşa Tıp Dergisi. 2002; 33(4): 236 - 244.
Vancouver BENİAN A,ULUDAĞ S,ATIŞ A,Gök M,Madazli R Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi. Cerrahpaşa Tıp Dergisi. 2002; 33(4): 236 - 244.
IEEE BENİAN A,ULUDAĞ S,ATIŞ A,Gök M,Madazli R "Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi." Cerrahpaşa Tıp Dergisi, 33, ss.236 - 244, 2002.
ISNAD BENİAN, Ali vd. "Doğumda bakılan umbilikal kordon kan gazı değerlerinin önemi". Cerrahpaşa Tıp Dergisi 33/4 (2002), 236-244.