Umbilical arterial pH in patients with cerebral palsy.
BACKGROUND
Umbilical arterial pH (UApH) in severe cerebral palsy (CP) is not fully understood.


OBJECTIVE
This work aims to determine the relationship between fetal acidemia and clinical features of severe CP.


METHODS
A retrospective study design is used.


METHODS
A review was conducted unti1 April 2013 among 218 infants with CP diagnosed to be caused by antenatal and/or intrapartum conditions determined by the Japan Council for Quality Health Care. After excluding patients in whom the causes of CP were thought to be due to events after delivery, 168 infants born at over 34weeks of gestation that both Apgar score and UApH were measured were selected.


METHODS
Severe fetal acidemia was defined as a pH of less than 7.0.


RESULTS
Six major factors were found to be associated with CP: placental abruption (A, n=42), traumatic delivery with an abnormal FHR pattern (B, n=29), an abnormal FHR pattern during labor (C, n=27), chorioamnionitis with an abnormal FHR pattern (D, n=17), an abnormal FHR pattern before labor (E, n=14), and cord prolapse (F, n=10). The UApH was less than 7.0 in 114 cases (67.9%) and more than 7.20 in 20 cases (11.9%). The UApH values were lowest in group A (median 6.7, 6.43-6.99) and highest in group E (7.18, 6.92-7.45). The distribution of the UApH values was significantly different in these groups.


CONCLUSIONS
Placental abruption was a factor most associated with low pH. Even among the infants with severe CP, over 10% of patients exhibited a non-acidemic status at birth.
Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi 329-2763, Japan; Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Kawada-cho, 8-1, Shinjuku-ku, Tokyo 162-8666, Japan. Electronic address: yoshiom2979@gmail.com.
Yoshio
Y
Matsuda
Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi 329-2763, Japan.
Hikaru
H
Umezaki
Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Kawada-cho, 8-1, Shinjuku-ku, Tokyo 162-8666, Japan.
Masaki
M
Ogawa
Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi 329-2763, Japan.
Michitaka
M
Ohwada
Maternal and Perinatal Care Center, Oita Prefectural Hospital, Bunyo 476, Oita 870-8511, Japan.
Shoji
S
Satoh
Tama-Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama-City, Tokyo 206-8512, Japan.
Akihito
A
Nakai
D002547:Cerebral Palsy / Q000097:blood* / Q000209:etiology; D005260:Female; D005312:Fetal Blood / Q000378:metabolism; D005315:Fetal Diseases / Q000097:blood* / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D014469:Umbilical Arteries / Q000503:physiopathology*
Cerebral palsy; Chorioamnionitis; Intraparum hypoxic event; Placental abruption; Umbilical arterial pH