Comparison of umbilical arterial and venous lactate and base excess values and its neonatal outcome in high-risk pregnancies

Abstract

Aim and objective: The aim and objective of the study was to compare the paired umbilical arterial and umbilical venous blood gas analysis and its neonatal outcome in high-risk pregnancies at a risk of perinatal asphyxia. Materials and methods: A 10–20 cm segment of umbilical cord was doubly clamped above the previous clamp immediately after delivery. Both the samples were sent for analysis immediately not exceeding 15 minutes. Blood gas analysis was done by ABG analyzer. Results were collected and compared. APGAR at 1 and 5 minutes of the neonate was noted. Results: Sensitivity for APGAR at 5 minutes obtained for a mean value of 4.5 mmol/L for arterial lactate was 94% and the specificity was 32%. For a base excess mean value of −10 mmol/L in the arterial sample, sensitivity was 81% and specificity was 32% observed for APGAR. When lactate was compared to arterial base excess, the area under the receiver operating characteristic (ROC) curve was higher for base excess. Conclusion: Comparison of paired cord blood gas analysis of pH, lactate, and base excess is a valuable adjunct to guide the management of newborns in high-risk pregnancies. In our study, umbilical arterial sample was superior to venous sample in predicting neonatal outcome. Clinical significance: Paired umbilical gas analysis is an effective method of practice for predicting neonatal acidemia in high-risk pregnancies. Both lactate and base excess had a high negative predictive value for predicting birth asphyxia that will work as an obstetric quality measure as well as an audit tool.