Yoshio Matsuda1, Hikaru Umezaki2, Masaki Ogawa3, Michitaka Ohwada2, Shoji Satoh4, Akihito Nakai5. 1. Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi 329-2763, Japan; Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Kawada-cho, 8-1, Shinjuku-ku, Tokyo 162-8666, Japan. Electronic address: yoshiom2979@gmail.com. 2. Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi 329-2763, Japan. 3. Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Kawada-cho, 8-1, Shinjuku-ku, Tokyo 162-8666, Japan. 4. Maternal and Perinatal Care Center, Oita Prefectural Hospital, Bunyo 476, Oita 870-8511, Japan. 5. Tama-Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama-City, Tokyo 206-8512, Japan.
Abstract
BACKGROUND: Umbilical arterial pH (UApH) in severe cerebral palsy (CP) is not fully understood. AIMS: This work aims to determine the relationship between fetal acidemia and clinical features of severe CP. STUDY DESIGN: A retrospective study design is used. SUBJECTS: A review was conducted unti1 April 2013 among 218 infants with CP diagnosed to be caused by antenatal and/or intrapartum conditions determined by the Japan Council for Quality Health Care. After excluding patients in whom the causes of CP were thought to be due to events after delivery, 168 infants born at over 34weeks of gestation that both Apgar score and UApH were measured were selected. OUTCOME MEASURES: Severe fetal acidemia was defined as a pH of less than 7.0. RESULTS: Six major factors were found to be associated with CP: placental abruption (A, n=42), traumatic delivery with an abnormal FHR pattern (B, n=29), an abnormal FHR pattern during labor (C, n=27), chorioamnionitis with an abnormal FHR pattern (D, n=17), an abnormal FHR pattern before labor (E, n=14), and cord prolapse (F, n=10). The UApH was less than 7.0 in 114 cases (67.9%) and more than 7.20 in 20 cases (11.9%). The UApH values were lowest in group A (median 6.7, 6.43-6.99) and highest in group E (7.18, 6.92-7.45). The distribution of the UApH values was significantly different in these groups. CONCLUSION: Placental abruption was a factor most associated with low pH. Even among the infants with severe CP, over 10% of patients exhibited a non-acidemic status at birth.
BACKGROUND: Umbilical arterial pH (UApH) in severe cerebral palsy (CP) is not fully understood. AIMS: This work aims to determine the relationship between fetal acidemia and clinical features of severe CP. STUDY DESIGN: A retrospective study design is used. SUBJECTS: A review was conducted unti1 April 2013 among 218 infants with CP diagnosed to be caused by antenatal and/or intrapartum conditions determined by the Japan Council for Quality Health Care. After excluding patients in whom the causes of CP were thought to be due to events after delivery, 168 infants born at over 34weeks of gestation that both Apgar score and UApH were measured were selected. OUTCOME MEASURES: Severe fetal acidemia was defined as a pH of less than 7.0. RESULTS: Six major factors were found to be associated with CP: placental abruption (A, n=42), traumatic delivery with an abnormal FHR pattern (B, n=29), an abnormal FHR pattern during labor (C, n=27), chorioamnionitis with an abnormal FHR pattern (D, n=17), an abnormal FHR pattern before labor (E, n=14), and cord prolapse (F, n=10). The UApH was less than 7.0 in 114 cases (67.9%) and more than 7.20 in 20 cases (11.9%). The UApH values were lowest in group A (median 6.7, 6.43-6.99) and highest in group E (7.18, 6.92-7.45). The distribution of the UApH values was significantly different in these groups. CONCLUSION: Placental abruption was a factor most associated with low pH. Even among the infants with severe CP, over 10% of patients exhibited a non-acidemic status at birth.