Abstract:
BACKGROUND:The Apgar score is universally used for fetal assessment at the time of birth, whereas, the collection of fetal cord blood gases is performed commonly in high-risk situations or in the setting of Apgar scores of <7, which is a less standardized approach. It has been well-established that neonatal acidemia at the time of delivery can result in significant neonatal morbidity and death. Because of this association, knowledge of the fetal acid-base status and detection of acidemia at the time of delivery can serve as a sensitive and useful component in the assessment of a neonate's risk. Umbilical cord blood gas analysis is an accurate and validated tool for the assessment of neonatal acidemia at the time of delivery. Because the collection of fetal cord blood gases is not a standardized practice, it is possible that, with such a varied approach, some cases of neonatal acidemia are not detected, particularly in the setting of reassuring Apgar scores. OBJECTIVE:In a setting of universally obtained cord blood gases, we sought to identify the rates of acidemia and associated factors in neonates with 5-minute Apgar scores of ≥7. STUDY DESIGN:This retrospective cohort study identified all term, singleton, nonanomolous neonates with 5-minute Apgar scores of ≥7. The incidence of umbilical artery pH ≤7.0 or ≤7.1 and base excess ≤-12 mmol/L or ≤-10 mmol/L were examined overall and in association with obstetric complications and adverse neonatal outcomes. Chi-squared tests were used to compare proportions, and multivariable logistic regression was used to control for potential confounders. RESULTS:In this cohort, the incidence of an umbilical artery pH of ≤7.0 was 0.5%, of a pH ≤7.1 was 3.4%, of a base excess ≤-12 mmol/L was 1.4%, and of ≤-10 mmol/L was 4.0%. Rates of neonatal acidemia were greater in the setting of meconium (4.3% vs 3.2%; P<.001), placental abruption (13.2% vs 3.4%; P<.001), and cesarean deliveries (5.8% vs 2.8%; P<.001), despite normal 5-minute Apgar scores. Additionally, umbilical artery pH ≤7.0 was associated with an increased risk of respiratory distress syndrome (adjusted odds ratio, 6.5; 95% confidence interval, 2.9-14.3) and neonatal intensive care unit admission (adjusted odds ratio, 10.8; 95% confidence interval, 6.8-17.4). Base excess of ≤-12 mmol/L was also associated with an increased risk of neonatal sepsis (adjusted odds ratio, 4.7; 95% confidence interval, 1.9-12.1). Finally, when examined together, neonates with both a pH of ≤7.0 and base excess of ≤-12 mmol/L continued to demonstrate an increased risk of neonatal intensive care unit admission and respiratory distress syndrome, with adjusted odds ratios of 9.6 and 6.0, respectively. This risk persisted in neonates with a pH of ≤7.1 and base excess of ≤-10 mmol/L as well, with adjusted odds ratios of 4.5 and 1.1, respectively. CONCLUSION:Because neonates with reassuring Apgar scores have a residual risk of neonatal acidemia that is associated with higher rates of adverse outcomes, the potential utility of obtaining universal cord blood gases should be further investigated.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Sabol BA,Caughey ABdoi
10.1016/j.ajog.2016.05.035subject
Has Abstractpub_date
2016-10-01 00:00:00pages
486.e1-6issue
4eissn
0002-9378issn
1097-6868pii
S0002-9378(16)30251-4journal_volume
215pub_type
杂志文章abstract:OBJECTIVE:The objective of this study was to determine the accuracy of clinical assessment of paravaginal defects in women with anterior vaginal wall prolapse. STUDY DESIGN:A retrospective chart review of all women undergoing surgery for anterior vaginal wall prolapse during the years of 1994 to 1996 identified operat...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(99)70440-0
更新日期:1999-07-01 00:00:00
abstract::This article is from the "To The Point" series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. The purpose of this review was to provide an overview of the importance of well-being in medical education. A literature search was performed by a Reference L...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2019.05.012
更新日期:2019-12-01 00:00:00
abstract:BACKGROUND:Hyperglycosylated human chorionic gonadotropin, the predominant human chorionic gonadotropin variant secreted following implantation, is associated with trophoblast invasion. OBJECTIVE:To determine whether the initial serum hyperglycosylated human chorionic gonadotropin differs between ongoing and failed pr...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2019.08.004
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine whether hysteroscopy improves the detection and extraction of endometrial polyps in postmenopausal women. This method was compared with curettage complemented by Randall polyp forceps. STUDY DESIGN:In a prospective study hysteroscopy was performed before and after curet...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.108332
更新日期:2001-01-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine what factors occurring after digital separation of the chorionic membranes from the lower uterine segment (membrane stripping) are involved in observed clinical changes compared with patients not so treated. STUDY DESIGN:Thirty patients were randomly divided among a study populat...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9378(93)90134-5
更新日期:1993-07-01 00:00:00
abstract::Plasma amino acid analyses on 27 amino acids in serial samples from 15 pregnancies in 14 patients are reported. Variations of amino acid levels with gestational age are reported both for absolute amino acid levels and for levels normalized to total amino acids, with a t test used to determine which amino acids vary si...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(78)90108-4
更新日期:1978-07-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to estimate US rates of postpartum intrauterine device (IUD) insertion and postpartum tubal sterilization. STUDY DESIGN:Data from the 2001-2008 Nationwide Inpatient Sample were used to identify delivery hospitalizations with IUD insertion or tubal sterilization procedure codes. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2011.08.004
更新日期:2012-02-01 00:00:00
abstract::In mothers with anti-Ro-positive antibodies whose previous pregnancies have ended in deliveries of infants with congenital heart block, prophylactic therapeutic strategies are used to try to diminish the production and passage into fetal circulation of autoantibodies. Intravenous gamma globulin was given at 14 and 18 ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90362-u
更新日期:1991-11-01 00:00:00
abstract:OBJECTIVE:Intrapartum fetal heart rate (FHR) recordings in twins were compared for fetal signal loss during both stages of labor to assess the quality of these recordings by the method that had been used: external ultrasound or directly via a scalp electrode. STUDY DESIGN:Analysis of recordings collected between Janua...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.04.037
更新日期:2004-12-01 00:00:00
abstract::In the present study second-trimester maternal serum alpha-fetoprotein levels were analyzed from 146 pregnancies associated with fetal open spina bifida to identify whether affected pregnancies from the black population were associated with higher maternal serum alpha-fetoprotein levels than their white counterparts. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90379-l
更新日期:1990-02-01 00:00:00
abstract::Fetal outcome in 98 patients with spontaneous antepartum late decelerations was studied by combining the data of two obstetric departments. Heart rate variability was used to classify the different patterns into two categories: terminal and decelerative. In 14 of the 47 pregnancies in which a terminal pattern was foun...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)90141-6
更新日期:1980-10-15 00:00:00
abstract::We evaluated the relation between age at menopause and the risk of nonfatal myocardial infarction (MI) among 121,964 nurses who responded to a mail questionnaire. Of 279 women who reported having been hospitalized for MI, 123 (44%) were postmenopausal (i.e., no longer menstruating) at the time of hospitalization, comp...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(81)90410-5
更新日期:1981-01-01 00:00:00
abstract:OBJECTIVE:Women with a history of preeclampsia (PE) have an increased prevalence of cardiometabolic, cardiovascular, and prothrombotic risk factors. Remotely, these women are at increased risk of developing cardiovascular and thrombotic disease. Decidual vasculopathy (DV) describes vascular lesions in the maternal spir...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2013.12.029
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:This study was undertaken to determine whether adrenomedullin, a hypotensive peptide, decreases vasomotor tone in fetoplacental vasculature that has been constricted with the thromboxane sympathomimetic U46619. STUDY DESIGN:The fetoplacental vascular beds of 20 perfused human placental cotyledons were vasoco...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.108071
更新日期:2000-12-01 00:00:00
abstract::The aerobic and anaerobic cervical microflora was determined before operation and on day 4 after operation in groups of women undergoing a clinical trial of prophylaxis with three doses of cefoxitin, cefazolin, or placebo for infectious complications of nonelective cesarean section. Floral shifts occurred post partum,...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/0002-9378(84)90109-1
更新日期:1984-08-01 00:00:00
abstract:OBJECTIVE:We sought to assess changes in indications, technique, successful fluid aspiration, and pregnancy outcomes in a large cohort of genetic amniocenteses performed by a single physician. STUDY DESIGN:Records were reviewed regarding 4600 women who underwent genetic amniocentesis by a single physician between 1972...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.116737
更新日期:2001-08-01 00:00:00
abstract::Fifty-seven prenatal patients with no known exposure to the element mercury, or any of its compounds, were observed for change in whole blood total mercury concentration from the initial prenatal clinic examination through delivery and postpartum hospitalization. On hospital admission for labor and delivery, whole blo...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(82)90087-4
更新日期:1982-06-15 00:00:00
abstract::Cholesterol metabolism was studied in cells from two established gynecologic cancer cell lines which were maintained in monolayer cultures. The cell lines were derived and established from poorly differentiated epidermoid cervical carcinoma (EC-50) and endometrial adenocarcinoma (AC-258). The specific activity of 3-hy...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(81)90952-2
更新日期:1981-04-15 00:00:00
abstract::Alternatives to regimens with mifepristone and a prostaglandin analog for medical abortion emerged because of the need for accessible, effective, and safe options in areas of the world where mifepristone was unavailable. Studies of oral or intramuscular methotrexate combined with misoprostol have demonstrated complete...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1067/mob.2000.107949
更新日期:2000-08-01 00:00:00
abstract::The luteolytic activity of oxymetholone, and anabolic steroid, has been evaluated in 10 women. Administration early in the follicular phase of the cycle inhibited ovulation and prolonged the duration of the cycles in 2 of 3 subjects, but treatment beginning on Day 10 (3 subjects) did not prevent ovulation, although su...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(75)90987-4
更新日期:1975-01-01 00:00:00
abstract::This study attempts quantification of prostaglandins (PGs) in amniotic fluid antepartum at 24, 26-33, 34-36 weeks of gestation and in labor in 6 normal patients, 6 diabetic patients, 3 patients taking methadone, and 1 patient taking heroin. Results of measurements of PGs showed that in the different weeks of gestatio...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(16)33793-0
更新日期:1974-02-01 00:00:00
abstract::Normal and genetic variant strains of nonmalignant human fibroblasts produce in vitro a substance indistinguishable from the recently described "pregnancy-specific" beta-1 glycoprotein (PSbetaG, PAPP-C, SP1). Demonstration of this presumed placenta-specific material in a nonplacental site raises questions about its no...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(79)90938-4
更新日期:1979-08-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to describe trends and outcomes of planned births. STUDY DESIGN:Data from linked birth and hospital records for 779,521 singleton births at ≥33 weeks' gestation from 2001-2009 were used to determine trends in planned births (prelabor cesarean section and labor inductions). Adver...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2012.06.082
更新日期:2012-09-01 00:00:00
abstract::The American College of Obstetricians and Gynecologists recommends that women with previous low transverse cesarean sections who are candidates for a trial of labor should undergo such a trial only in a special environment. Such recommendations imply that these women are at greater risk than the general population for...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90321-2
更新日期:1986-11-01 00:00:00
abstract::Intrapartum fetal heart rate and subcutaneous scalp PO2 were continuously measured with a combined electrocardiogram-PO2 needle electrode in 34 patients. The incidence of fetal heart rate abnormalities increased significantly with decreasing subcutaneous PO2, from 0.8% of the 10-minute periods in which subcutaneous PO...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(85)90476-4
更新日期:1985-11-01 00:00:00
abstract:OBJECTIVE:The mechanism underlying myometrial quiescence during pregnancy is unknown. Our group has previously shown that during pregnancy myometrial cyclic guanosine monophosphate content rises to several hundred times the nonpregnant levels, only to abruptly decline days before the onset of labor. Cyclic guanosine mo...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.107462
更新日期:2000-12-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to examine weight and its relationship to glucose intolerance during pregnancy. STUDY DESIGN:Women were classified into mutually exclusive glucose tolerance groups; impaired glucose tolerance of pregnancy defined as 1 high value on the oral glucose tolerance test, gestational d...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.05.017
更新日期:2006-12-01 00:00:00
abstract::Botulinum toxin A is the newest therapy for the treatment of a variety of medical disorders caused by abnormalities of muscle activity. After successful use in other medical subspecialties, the newest applications of this potent neurotoxin are within the lower urinary tract. The toxin has evolved from a cause of fatal...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2006.03.108
更新日期:2007-01-01 00:00:00
abstract::A randomized, comparative study of two low-dose oral contraceptives was carried out in 60 nonpregnant women for 12 cycles. Twenty-eight women took a preparation containing 150 micrograms of desogestrel and 30 micrograms of ethinyl estradiol; 32 took 75 micrograms of gestodene and 30 micrograms of ethinyl estradiol. Ba...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9378(90)91357-i
更新日期:1990-10-01 00:00:00
abstract::An antiserum to 13,14-dihydro-15-keto-prostaglandin F2alpha (PGF2alphaM) was prepared and a radioimmunoassay evaluated in various reproductive states. PGF2alphaM plasma concentration was 63.6 +/- 10.3 pg/ml (mean +/- SEM) in cycling women. The concentration fluctuated throughout the menstrual cycle and pregnancy, but ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(16)33031-9
更新日期:1979-06-01 00:00:00