산과적 요인이 제대혈 가스분석에 미치는 영향 = The Effect of Obstetric Factors on the Umbilical Cord Blood Acid-Base and Gas Measurements

다국어 초록 (Multilingual Abstract)

Backgrounds/Objective: Asphyxia is major cause of perinatal morbidity and mortality. The Apgar score is not only subjective but also less predictive of aspyxia or acidemia than umbilical cord gas measurements, which reflects the closest metabolic state of fetus just before the birth. The purpose of this study is to evaluate that the umbilical nenous gas measurement is as useful as umbilical arterial gas measurement as a marker of neonatal metabolic state and to assess the obstetric factors(maternal anemia, spontaneous premature rupture of membrane, fetal heart deceleration during labor, decreased amniotic fluid volume, meconium staining, nuchal cord, mode of delivery, ect) on the cord blood ags measurement. Material and methods: Umbilical cord acid-base and gas measurements was performed on the 209 cases of term (35-42.9 gestational weeks), singleton neonates with vertes presentation and with no significant congenital malformation. Cord blood was obtained from umbilical artery and vein at the time of birth before first crying through 3 ml syringe flushed with heparin. The gas analysis was done with autoanalyser(ABL 520 and IL 1312). Statistical analysis was performed with two-paired student T-test. Results: The mean acid-base gas measurements between umbilical artery and vein showed significant difference and the change pattern in umbilical nenous gas measurement is reflective of that in umbilical artery. The mean umbilical arterial and venous pH, base excess of neonates with spontaneous premature rupture of membrane(SPRM) were significantly lower than those of neonates without SPRM. The mean umbilical arterial and venous pH, HCO3, base excess of neonates with decreased amniotic fluid volume were significantly lower than those of neonates with normal amniotic fluid volume. The mean umbilical arterial and venous pH, pO2, HCO3 and base excess of neonates with vaginal delivery were significantly lower than those of neonates with Cesarean section. So, SPRM, decreased amniotic fluid volume and vaginal delivery showed effect of tendency toward the metabolic acidosis on umbilical blood, reflecting hypoxic stress but which is rarely of clinical significance. Conclusion: The umbilical venous acid-base gas measurements is as valuable as umbilical arterial measurements in evaluating the metabolic state of fetus. The umbilical artery and venous acid-base gas measurement is useful marker for assessing the antepartum and intrapartum management, in addition to direct reflection of fetal asphyxia. So umbilical blood gas analysis is recommended as rountine procedure in delivery unit.