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Arterio-venous blood gas Δvalues for validation of umbilical cord blood samples at birth are not only biased by sample mix ups but also affected by clinical factors

Mokarami, Parisa LU ; Wiberg, Nana LU ; Källén, Karin LU and Olofsson, Per LU (2019) In Acta Obstetricia et Gynecologica Scandinavica 98(2). p.167-175
Abstract

Introduction: Traditional validation of umbilical cord blood samples with positive veno-arterial ΔpH and arterio-venous ΔpCO2 values confirms the source of samples, whereas negative Δvalues represent mix-up of samples. To investigate whether this is true, the distributions of V-A ΔpO2 and A-V Δlactate were also explored and related to clinical characteristics. In addition, different cord blood sampling techniques were evaluated. Material and methods: Register study with cord blood acid-base and clinical data from 27 233 newborns. Clinical characteristics were related to positive, zero and negative Δvalues. Blood samplings from unclamped and double-clamped cords were compared. A two-sided P < 0.05 was considered... (More)

Introduction: Traditional validation of umbilical cord blood samples with positive veno-arterial ΔpH and arterio-venous ΔpCO2 values confirms the source of samples, whereas negative Δvalues represent mix-up of samples. To investigate whether this is true, the distributions of V-A ΔpO2 and A-V Δlactate were also explored and related to clinical characteristics. In addition, different cord blood sampling techniques were evaluated. Material and methods: Register study with cord blood acid-base and clinical data from 27 233 newborns. Clinical characteristics were related to positive, zero and negative Δvalues. Blood samplings from unclamped and double-clamped cords were compared. A two-sided P < 0.05 was considered significant. Results: ΔpH and ΔpCO2 values distributed into positive, around zero, and negative sub-populations, with significant differences in pH and clinical characteristics between sub-populations. No such sub-populations were distinguished for ΔpO2 and Δlactate. The 2.5th and 5th ΔpH percentiles were 0.013 and 0.022, respectively, and for ΔpCO2 0.30 and 0.53 kPa. Applying 5th percentile criteria resulted in 3.5% of “approved” cases showing a ΔpO2 ≤ 0. Puncture and sampling of the unclamped cord resulted in significantly better sample quality. Conclusions: Unphysiological negative ΔpO2 values occurred despite correct validation with traditional criteria. Δlactate cannot be used for validation because both positive and negative values are physiological. Positive/around zero/negative ΔpH and ΔpCO2 sub-populations were associated with significant differences in pH and clinical characteristics, indicating that defective sampling and sample handling are not the sole explanations for negative Δvalues. Prompt puncture and sampling of the unclamped cord resulted in best sample quality.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
blood gases, delayed sampling, lactate, pCO, pH, pO, pregnancy, umbilical cord, validation
in
Acta Obstetricia et Gynecologica Scandinavica
volume
98
issue
2
pages
167 - 175
publisher
Wiley-Blackwell
external identifiers
  • scopus:85055870365
  • pmid:30256382
ISSN
0001-6349
DOI
10.1111/aogs.13471
language
English
LU publication?
yes
id
ab69d262-975c-41be-9e9e-72ac5204d425
date added to LUP
2018-11-19 14:23:18
date last changed
2019-12-03 01:54:18
@article{ab69d262-975c-41be-9e9e-72ac5204d425,
  abstract     = {<p>Introduction: Traditional validation of umbilical cord blood samples with positive veno-arterial ΔpH and arterio-venous ΔpCO<sub>2</sub> values confirms the source of samples, whereas negative Δvalues represent mix-up of samples. To investigate whether this is true, the distributions of V-A ΔpO<sub>2</sub> and A-V Δlactate were also explored and related to clinical characteristics. In addition, different cord blood sampling techniques were evaluated. Material and methods: Register study with cord blood acid-base and clinical data from 27 233 newborns. Clinical characteristics were related to positive, zero and negative Δvalues. Blood samplings from unclamped and double-clamped cords were compared. A two-sided P &lt; 0.05 was considered significant. Results: ΔpH and ΔpCO<sub>2</sub> values distributed into positive, around zero, and negative sub-populations, with significant differences in pH and clinical characteristics between sub-populations. No such sub-populations were distinguished for ΔpO<sub>2</sub> and Δlactate. The 2.5th and 5th ΔpH percentiles were 0.013 and 0.022, respectively, and for ΔpCO<sub>2</sub> 0.30 and 0.53 kPa. Applying 5th percentile criteria resulted in 3.5% of “approved” cases showing a ΔpO<sub>2</sub> ≤ 0. Puncture and sampling of the unclamped cord resulted in significantly better sample quality. Conclusions: Unphysiological negative ΔpO<sub>2</sub> values occurred despite correct validation with traditional criteria. Δlactate cannot be used for validation because both positive and negative values are physiological. Positive/around zero/negative ΔpH and ΔpCO<sub>2</sub> sub-populations were associated with significant differences in pH and clinical characteristics, indicating that defective sampling and sample handling are not the sole explanations for negative Δvalues. Prompt puncture and sampling of the unclamped cord resulted in best sample quality.</p>},
  author       = {Mokarami, Parisa and Wiberg, Nana and Källén, Karin and Olofsson, Per},
  issn         = {0001-6349},
  language     = {eng},
  number       = {2},
  pages        = {167--175},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Obstetricia et Gynecologica Scandinavica},
  title        = {Arterio-venous blood gas Δvalues for validation of umbilical cord blood samples at birth are not only biased by sample mix ups but also affected by clinical factors},
  url          = {http://dx.doi.org/10.1111/aogs.13471},
  doi          = {10.1111/aogs.13471},
  volume       = {98},
  year         = {2019},
}