Umbilical Cord Blood pH in Intrapartum Hypoxia.

OBJECTIVE: To determine the association of cord arterial blood pH with neonatal outcome in cases of intrapartum fetal hypoxia. STUDY DESIGN: Descriptive analytical study. PLACE AND DURATION OF STUDY: Gynaecology Unit-II, Civil Hospital, Karachi, from September 2011 to November 2012. METHODOLOGY: All singleton cephalic fetuses at term gestation were included in the study. Those with any anomaly, malpresentation, medical disorders, maternal age < 18 years, multiple gestation and ruptured membranes were excluded. Patients with abnormal cardiotocography and/or meconium stained liquor were enrolled as index case and immediate next delivery with no such signs as a control. Demographic characteristics, pH level < or > 7.25, neonatal outcome measures (healthy, NICU admission or neonatal death), color of liquor and mode of delivery recorded on predesigned proforma. Statistical analysis performed by SPSS 16 by using independent-t test or chi-square test and ANOVA test as needed. RESULTS: A total of 204 newborns were evaluated. The mean pH level was found to be significantly different (p=0.007) in two groups. The pH value 7.25 had significant association (p < 0.001) with the neonatal outcome. However, the association of neonatal outcome with severity of acidemia was not found to be significant. Grading of Meconium Stained Liquor (MSL) also did not relate positively with pH levels as 85.7% of grade I, 68.9% of grade II and 59.4% of grade III MSLhad pH > 7.25. Majority (63.6%) cases needed caesarean section as compared to 31.4% controls. CONCLUSION: There is a significant association of cord arterial blood pH at birth with neonatal outcome at pH < or > 7.25; but below the level of pH 7.25 it is still inconclusive.

Perinatal mortality contributors in singleton gestation.

OBJECTIVE: To determine the feto-maternal factors contributing to perinatal mortality (PNM) in singleton gestation. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Gynae Unit-III, Civil Hospital, Karachi, from January to December 2002. METHODOLOGY: All obstetric patients with singleton pregnancy and gestation age greater than 24 weeks, regardless of age, parity and gravidity attending the gynae unit III in labor room and ward were recruited. Patients with gestational age less than 24 weeks or multiple pregnancy were excluded. Relevant data regarding history, risk factors in mother and baby were recorded on a pre-designed pro forma and later analyzed on SPSS 10 for descriptive statistics and comparison of proportions using chi-square statistics. Neonatal death was defined as live born infant who died before 28 days of age. Still birth encompassed any death of a fetus after 20 weeks of gestation or 500 gms, and perinatal mortality was considered as the sum of the still birth and neonatal death. RESULTS: In the 1505 studied mothers, the perinatal loss was 187(12.43%) including 140 still births and 47 neonatal deaths (3.12%). Perinatal mortality rate (PNMR) was 124/1000 total live births and neonatal death rate (NNDR) was 34/1000 live births. The commonest cause of still birth was antepartum hemorrhage (33.5%) and the commonest cause of NND was birth asphyxia (64%). PNM in relation to neonatal birth weight was highest in the 2.5 - 3.5 kg range i.e. 70 (50%, p=0.86). The proportion of primi/multi parity was 60 (45%) and 23 (49%) in still birth and neonatal deaths respectively (p=0.308). The leading causes of prematurity were antepartum hemorrhage, hypertensive disorders and chorioamnionitis. CONCLUSION: Perinatal mortality is markedly affected by fetal maturity. Parity and fetal weight have an insignificant effect on perinatal mortality.