Brian M.

Lappas
April 26, 2013

Umbilical Cord Blood Gas Analysis

Umbilical cord blood gas is the most objective way of assessing a newborns metabolic condition at birth.
Specifically, arterial cord pH and base deficit can determine perinatal hypoxia/asphyxia (potential causes
of hypoxic-ischemic encephalopathy or cerebral palsy) and give insight into causes of intrapartum fetal
distress.
When are cord blood gases indicated? including but not limited to:
High risk pregnancies
-C-section for fetal compromise
-Abnormal fetal heart rate patterns
-Low (3) Apgar score
-Intrapartum fever >100.4 C
-Multifetal gestation
Why do neonates get hypoxic/asphyxia?
3 main etiologies:
-Maternal oxygen compromised
-Maternal perfusion of placenta reduced
Preeclampsia, chronic hypertension, hypotension/hypovolemia, cyanotic heart disease
-Delivery of oxygenated blood from placenta to fetus is impaired
Placental abruption, cord prolapse, repetitive cord occlusion
How should it be collected and stored?
-10 to 20cm section of cord double clamped and put on ice
- Assessed accurately up to 60min, pH fall 0.05 at 30min, 0.087 at 60min, and 0.112 at 90min.
-Sample via cord artery, although paired venous sample recommended (artery < 0.09 venous)
What do the blood gases tell us?
Mean umbilical artery blood pH and gas in pre-term & term infants are similar
Pre-Term
Term
pH
7.21 -7.29
7.27 -7.28
pCO2 (mmHg)
49.2 -51.6
49.2 -50.3
HCO3 (mEq/L)
22.4-23.9
22.0-23.1
Base deficit (mEq/L)
2.5 - 3.3
2.7 - 3.6
Results of hypoxia/asphyxia on infants?
Pathological academia; increased association with 7.24 with mortality, hypoxic ischemic
encephalopathy, intraventricular hemorrhage, or cerebral palsy.
Severity of Deficit
Mild
Moderate
Severe

Amount of base deficit

Motor/Cognitive deficits 4-8 yo
4-8 mmol/L
None
8-12 mmol/L
12 mmol/L
10% had moderate/severe
16 mmol/L
40% had moderate/severe
-Only 4% of neonatal encephalopathic patients had hypoxia in absence of antepartum risk factors

Criteria to define aute intrapartum hypoxic event as sufficient to cause cerebral palsy:
- Evidence of metabolic acidosis (pH <7.0 and base deficit greater/equal 12 mmol/L)
- Early onset of moderate/severe neonatal encephalopathy in infants >34 week gestation
- Cerebral palsy of spastic quadriplegic or dyskinetic type
- Exclusion of other identifiable etiologies
Why does UNC do universal sampling?
Because there is a treatment to help reduce the risk of death or major disability in hypoxic-ischemic
encephalopathy by 20-30%.
-Hypothermia: whole body cooling or head selective cooling is the neuroprotective therapy for
neonatal encephalopathy.

Resources:
- ACOG Committee Opinion No. 348, November 2006: Umbilical cord blood gas and acid-base analysis. Obstet Gynecol. 2006 Nov;108(5):1319-22.
-Low JA, Lindsay BG, Derrick EJ. Threshold of metabolic acidosis associated with newborn complications. Am J Obstet Gynecol 1997; 177: 1391-4
-Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis.
BMJ. 2010 May 13;340:c1471
-UNC Umbilical Cord Blood Gases: Fetal acid base assessment at time of delivery. www.mombaby.org 2013
-Yeomans ER, Ramin SM. Umbilical cord blood acid-base analysis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2013.