Acidemia at birth in the vigorous infant as a trigger incident to assess intrapartum care with regard to CTG patterns.
OBJECTIVE
To evaluate if acidemia in vigorous infants is a useful variable in the assessment of intrapartum care with regard to cardiotocographic (CTG) patterns during the second stage.


METHODS
Cases (n = 241) were infants with an umbilical artery pH < 7.05, controls (n = 482) were infants with pH ≥ 7.05. Apgar score was ≥ 7 at 5 min in both groups. CTGs during the last two hours of labor were assessed and neonatal outcomes compared. A sub-analysis of cases with metabolic acidemia: pH < 7.00 and base deficit ≥ 12 mmol/L and acidemia: 7.00 < pH < 7.05 was performed.


RESULTS
63% of cases had a pathological CTG versus 26% of controls (p < 0.001). Patterns with severe variable decelerations had a significantly longer duration in cases. Metabolic acidemia was significantly associated with severe variable decelerations and decreased variability. Infants to cases were admitted to neonatal care in 19% versus 2% of controls (p < 0.001). With metabolic acidemia, 32% were admitted.


CONCLUSIONS
An umbilical artery pH < 7.05 at birth of vigorous infants may be a useful variable for quality control of intrapartum management with regard to the assessment of second-stage CTGs. Differences in duration of pathological patterns indicate passiveness in academic cases.
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. maria.jonsson@kbh.uu.se
Maria
M
Jonsson
Solveig
S
Nordén Lindeberg
Ingrid
I
Östlund
Ulf
U
Hanson
D000138:Acidosis / Q000150:complications* / Q000151:congenital; D000328:Adult; D001034:Apgar Score; D015148:Cardiotocography / Q000592:standards*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007748:Labor Stage, Second / Q000502:physiology; D036801:Parturition / Q000502:physiology*; D018743:Perinatal Care / Q000592:standards; D011247:Pregnancy; D011785:Quality Assurance, Health Care; D014469:Umbilical Arteries / Q000737:chemistry; D055815:Young Adult