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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (1): 159-164. doi: 10.19723/j.issn.1671-167X.2019.01.027

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Predictive value of umbilical arterial cord pH on complications during hospitalization in neonates after cesarean section

Ju BAO1,Jia LIU2,Yuan QU1,Dong-liang MU1,△()   

  1. 1. Department of Anesthesiology,Peking University First Hospital,Beijing 100034, China
    2. Department of Operation Room,Peking University First Hospital,Beijing 100034, China
  • Received:2018-05-21 Online:2019-02-18 Published:2019-02-26
  • Contact: Dong-liang MU E-mail:mudongliang@icloud.com

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Abstract:

Objective: To analyze the predictive value of umbilical arterial cord pH on complications of hospitalized neonates after cesarean section. Methods: This was a retrospective cohort study and carried out in Peking University First Hospital from January 1,2017 to June 30,2017. Neonates who were deli-vered by cesarean section were enrolled. The primary endpoint was the incidence of complications during in-hospital stay (including infection,aspiration pneumonia,myocardial damage,etc.). The subjects were divided into two groups:with or without complication. The umbilical arterial cord pH values were compared between the two groups. Perinatal baseline characteristics of maternal and neonatal data were recorded. The ROC curve was used to analyze the value of umbilical arterial cord pH in predicting neonatal complications during hospitalization. Multivariate Logistic regression was employed to analyze the potential risk factors of neonatal complications. Results: In the study,872 neonates were included in the final analysis (541 in elective surgery and 331 in emergency surgery). The overall incidence of neonatal complications during hospitalization was 14.1%. The first three higher incidences were infection,aspiration pneumonia and myocardial damage. The average pH value in neonates without complication was 7.31 while 7.29 in neonates with complication. There was statistical significance between the two groups (P<0.001). The overall incidence of pH≤7.20 was 3.1% (27/872). The patients in neonates without complication had higher incidence of pH≤7.20 than those in neonates with complication (1.6% vs. 12.2%, P<0.001). Multivariate Logistic regression showed 6 risk factors of neonatal hospitalized complications including preterm delivery (OR=8.224,95%CI:4.910-13.777, P<0.001),pregnancy-induced hypertension (OR=1.886,95%CI:1.004-3.546,P=0.049), intrauterine growth restriction (OR=4.429,95%CI:1.280-15.330,P=0.019), emergency cesarean section (OR=2.711,95%CI:1.682-4.369,P<0.001),umbilical arterial blood gas pH≤7.20 (OR=7.420,95%CI:2.951-18.655,P<0.001) and 5-minute Apgar score <10 scores (OR=11.849,95%CI:3.977-35.128,P<0.001). The areas under the ROC curve of umbilical arterial blood gas pH in all neonatal,elective and emergency cesarean section were 0.570 (95%CI:0.508-0.633,P=0.012),0.559 (95%CI:0.465-0.652,P=0.189) and 0.617 (95%CI:0.538-0.697,P=0.002),respectively. Conclusion: Umbilical arterial cord pH≤7.20 was related with increased incidence of neonatal complications after cesarean section,but ROC curve analysis showed a lower predictive value.

Key words: Umbilical arteries, Blood gas analysis, Hydrogen-ion concentration, Infant, newborn, diseases, Cesarean section

CLC Number: 

  • R722.1

Table 1

Basic characteristics"

Variables Total
(n=872)		 Without complication
(n=749)		 With complication
(n=123)		 P value
Age (≥35 years), n (%) 339 (38.9) 296 (39.5) 43 (35.0) 0.370
BMI/(kg/m2), x?±s 28.05±3.65 27.98±3.59 28.54±3.94 0.138
Preterm (<37 weeks), n (%) 114 (13.1) 56 (7.5) 58 (47.2) <0.001
Gestation (frequency), median (minimum, maximum) 2 (1, 7) 2 (1, 7) 2 (1, 7) 0.128
Production (frequency), median (minimum, maximum) 1 (0, 3) 1 (0, 3) 1 (0, 3) 0.405
ASA classification, n (%) <0.001
Ⅰ 108 (12.4) 98 (13.1) 10 (8.1)
Ⅱ 709 (81.3) 621 (82.9) 88 (71.5)
Ⅲ 55 (6.3) 30 (4.0) 25 (20.3)
Maternal comorbidity, n (%)
Hypertension 30 (3.7) 26 (3.5) 4 (3.3) >0.999
Diabetes 21 (2.4) 20 (2.7) 1 (0.8) 0.341
Renal diseases 16 (1.8) 12 (1.6) 4 (3.3) 0.264
Previous cesarean delivery 278 (51.3) 253 (51.1) 25 (54.3) 0.758
PIH 87 (10.0) 55 (7.3) 32 (26.0) <0.001
GDM 248 (28.4) 211 (28.2) 37 (30.1) 0.667
Fetal conditions, n (%)
Twins 162 (18.6) 130 (17.4) 32 (26.0) 0.033
Cord around the neck 344 (39.4) 300 (40.1) 44 (35.8) 0.426
IUGR 18 (2.1) 9 (1.2) 9 (7.3) <0.001

Table 2

Perioperative data"

Variables Total (n=872) Without complication (n=749) With complication (n=123) P value
Emergency surgery, n (%) 331 (38.0) 254 (33.9) 77 (62.6) <0.001
Anesthetic technique, n (%) 0.019
Neuraxial anesthesia 843 (96.7) 729 (97.3) 114 (92.7)
General anesthesia 22 (2.5) 14 (1.9) 8 (6.5)
Combined anesthesia 7 (0.8) 6 (0.8) 1 (0.8)
Anesthesia time/min, x?±s 89.7±19.7 89.5±18.8 90.2±24.3 0.457
Operation time/min, x?±s 50.6±16.6 50.1±15.9 53.6±20.3 0.071
Hypotension, n (%)a 206 (23.6) 183 (24.4) 23 (18.7) 0.172
Volume transfusion/mL, x?±s 965.4±446.2 967.2±429.8 954.9±537.3 0.810
Neonatal conditions
Male, n (%) 462 (53.0) 392 (52.3) 70 (56.9) 0.381
Neonatal weight/g, x?±s 3 191.1±595.9 3 258.7±519.6 2 778.1±824.7 <0.001
1-min Apgar scores, x?±s 9.8±0.6 9.9±0.4 9.0±1.6 <0.001
5-min Apgar scores, x?±s 9.9±0.2 10.0±0.1 9.8±0.7 <0.001
UABGA pH, x?±s 7.30±0.05 7.31±0.04 7.29±0.08 0.003
UABGA pH classification, n (%) <0.001
≤7.20 27 (3.1) 12 (1.6) 15 (12.2)
Elective 5 (0.6) 4 (0.5) 1 (0.8)
Emergency 22 (2.5) 8 (1.1) 14 (11.4)
≥7.21 845 (96.9) 737 (98.4) 108 (87.8)
Elective 536 (61.5) 491 (65.6) 45 (36.6)
Emergency 309 (35.4) 246 (32.8) 63 (51.2)

Table 3

Risk factors of neonatal hospitalized complications"

Variables Univariate analysis Multivariate Logistic regression analysis
OR (95%CI) P OR (95%CI) P
Preterm delivery 11.042 (7.065-17.259) <0.001 8.224 (4.910-13.777) <0.001
Age>35 years 0.823 (0.552-1.225) 0.337
Twins 1.674 (1.073-2.613) 0.023
GDM 1.097 (0.723-1.664) 0.663
PIH 4.437 (2.725-7.225) <0.001 1.886 (1.004-3.546) 0.049
IUGR 6.491 (2.524-16.696) <0.001 4.429 (1.280-15.330) 0.019
ECS 3.262 (2.197-4.844) <0.001 2.711 (1.682-4.369) <0.001
Hypotension 0.711 (0.439-1.153) 0.167
UABGA pH≤7.20 8.530 (3.889-18.711) <0.001 7.420 (2.951-18.655) <0.001
5-min Apgar scores < 10 26.974 (10.682-68.113) <0.001 11.849 (3.977-35.128) <0.001

Figure 1

ROC curve of pH value on complications during hospitalization of neonates after cesarean section A, all neonates of cesarean section (AUC=0.570,P=0.012,95%CI: 0.508-0.633); B, neonates of selective cesarean section (AUC=0.559,P=0.189, 95%CI: 0.465-0.652); C, neonates of emergency cesarean section (AUC=0.617,P=0.002,95%CI: 0.538-0.697)."

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