Factors associated with umbilical artery acidemia in term infants with low Apgar scores at 5min

Locatelli, Anna; Incerti, Maddalena; Ghidini, Alessandro; Greco, Massimiliano; Villa, Elisabetta; Paterlini, Giuseppe

doi:10.1016/j.ejogrb.2008.01.003

« Previous Next »European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume 139, Issue 2 , Pages 146-150, August 2008

Factors associated with umbilical artery acidemia in term infants with low Apgar scores at 5min

Anna Locatelli
- Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Via Solferino 16, 20052 Monza (MI), Italy
- Corresponding author. Tel.: +39 039 233 4720; fax: +39 039 233 3820.
Maddalena Incerti
- Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Via Solferino 16, 20052 Monza (MI), Italy
Alessandro Ghidini
- Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Via Solferino 16, 20052 Monza (MI), Italy
Massimiliano Greco
- Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Via Solferino 16, 20052 Monza (MI), Italy
Elisabetta Villa
- Department of Neonatology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
Giuseppe Paterlini
- Department of Neonatology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy

Received 13 June 2007; received in revised form 3 December 2007; accepted 9 January 2008. published online 04 March 2008.

Abstract

Objective

To evaluate predictors of umbilical artery acidemia in term neonates with low Apgar score.

Study design

From a cohort of term singleton deliveries over a 13-year period, we selected neonates with 5-min Apgar score <7. Acidemia was defined as umbilical artery pH<7.00 or base excess (BE)≤−12mmol/L. Three pathogenic processes of neonatal acidemia were evaluated: (1) intrauterine vascular disease, defined as preeclampsia, clinical diagnosis of placental abruption, birth weight <10th centile, or histologic evidence of placental infarction or severe vascular pathology, (2) intrauterine infection, defined as clinical chorioamnionitis, histologic chorioamnionitis, or early neonatal sepsis, and (3) acute intrapartum events, which included cases of cord prolapse, amniotic fluid embolism, uterine rupture, sudden and sustained fetal bradycardia or absence of FHR variability with a previously normal pattern, shoulder dystocia or complicated breech extraction. The associations of such processes with umbilical artery evidence of acidemia were tested using χ², Fisher's exact test, Student's t-test, and logistic regression, with P<0.05 or odds ratio (OR) with 95% confidence interval (CI) not inclusive of the unity considered significant.

Results

Among the 27,395 neonates in the cohort, an Apgar score at 5min <7 was recorded in 94 (0.32%) and it was associated with umbilical artery acidemia in 33 cases. Logistic regression analysis showed that intrauterine vascular disease was independently associated with umbilical cord acidemia (P=0.035, OR=3.2, 95% CI=1.1–9.7) whereas intrauterine infection (OR=1.1, 95% CI 0.4–3.4) and acute intrapartum events (OR=2.1 95% CI 0.6–7.0) were not.

Conclusions

Umbilical artery evidence of acidemia is present in 38% of term babies with low Apgar score and it is predominantly associated with chronic antepartum vascular disease. Neither intrauterine infection nor acute intrapartum events are significantly associated with umbilical artery acidemia.

Keywords: Low Apgar score, Umbilical artery acidemia, Term pregnancy