The process of birth is the most dangerous journey any individual undertakes. The risk of the fetus being “asphyxiated during labor” - that is to encounter insufficient oxygen supply - is a substantial concern even in labor wards in high income countries. In 2012, WHO estimated that somewhere between 4 and 9 million newborns per year would suffer from intrapartum asphyxia. Approximately 25% of these would die and 25% would develop severe disabilities. Hence the detection during labor by electronic fetal monitoring (EFM) and acid-base analysis of fetal scalp blood samples is crucial to try to avoid asphyxia, and the analysis of the cord blood for acid-base status at delivery is of paramount importance to determine a possible neonatal asphyxia in order to immediately establish correct treatment.
The results of umbilical cord blood acid-base analysis can also be used retrospectively for the assessment of quality of care and/or for documentation in case of litigation.
This webinar will discuss key topics such as fetal acid-base physiology, pathophysiology of asphyxia during labor and why cord blood gas sampling and analysis at birth is important. Evidence of respiratory (hypercapnic) and metabolic acidosis, and it’s relation to poor outcomes in terms of neonatal encephalopathy will be presented. The specific use of fetal scalp-blood sampling during labor will be mentioned shortly, and the rationale and evidence for the use of cord blood lactate measurement will be presented. Finally, correct cord blood sampling collection and handling of cord blood gas specimens will be briefly discussed.
Jan Stener Jørgensen, MD PhD
Head of Obstetrics and Professor of Clinical Obstetrics
University of Southern Denmark