Neonatal complications at term as related to the degree of umbilical artery acidemia

Article Abstract:

Although deprivation of oxygen (asphyxia) for the infant during delivery is known to result in complications, agreement has not been reached concerning the level of oxygen deprivation that is detrimental. Reports differ on the definition of safe levels of umbilical artery pH (a measure of acidity), or fetal acidemia, acidity of the fetal blood that reflects its level of oxygenation. It is likely that a firm cut-off point cannot be established, and that damage results from a combination of factors. This was tested by studying 358 mother-infant pairs during an 18-month period at one medical institution. The fetal gestational age was 37 weeks or more. Umbilical artery pH of less than 7.20 was used to diagnose umbilical artery acidemia. A control group of 358 pairs was selected of similar gestational age, but with umbilical artery pH of 7.20 or greater. The type of acidemia was classified as respiratory (elevated levels of carbon dioxide and bicarbonate) in 44 percent of the group; metabolic (lower levels of carbon dioxide and bicarbonate) in 15 percent; or mixed in 41 percent. Apgar scores (a measure of physical function in the newborn), complications of pregnancy or delivery, and type of delivery, were noted. No differences were found between the groups with respect to number of previous births, race, birth weight, delivery mode, fetal distress, or neonatal complications. Average Apgar scores at one and five minutes after birth were lower for the 23 infants who had umbilical artery pH lower than 7.00 than for the remaining 693 with higher pH levels. No differences in Apgar scores were found according to the type of acidemia. Two infants in the acidemia group had complications related to asphyxia; their case reports are presented. The findings did not find a consistent pattern of neonatal complications in infants whose umbilical artery pH fell below 7.20. Analysis of umbilical artery pH is valuable, however, for determining if asphyxia has occurred. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Physiological aspects, Asphyxia neonatorum, Blood chemical analysis, Labor, Complicated, Labor complications, blood

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The relationship between maternal serum and amniotic fluid alpha-fetoprotein in women undergoing early amniocentesis

Article Abstract:

Several techniques for prenatal diagnosis that are accurate during the first trimester of pregnancy have been developed, including early amniocentesis (removal of a small amount of amniotic fluid, in which the fetus floats, with a syringe). Early amniocentesis, among other tests, allows for determination of levels of alpha-fetoprotein (AFP). If abnormal AFP levels are found, this generally indicates that the spine has remained open in development (called a neural tube defect). To learn more about measuring AFP levels in amniotic fluid and maternal blood during early pregnancy (12 to 14 weeks' gestation), the medical records of 148 women (average age, 37) from whom samples had been taken at 12, 13, and 14 weeks' gestation were reviewed. All infants were normal, with no open-spine defects. Results showed higher maternal blood AFP levels at week 14 than at weeks 12 and 13, while amniotic fluid AFP levels were highest at week 13. No correlation was found between AFP levels in blood and amniotic fluid. Thus, it appears that measurement of maternal blood AFP early in pregnancy would not give an accurate indication of the AFP levels in amniotic fluid and, by extension, of the probability of an open-spine defect. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Abnormalities, Birth defects, Neural tube, Neural tube defects, Prenatal diagnosis

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Maternal serum alpha-fetoprotein and dimeric inhibin A detect aneuploidies other than Down syndrome

Article Abstract:

The combination of maternal age, maternal serum alpha-fetoprotein, and dimeric inhibin A may detect aneuploidies other than Down syndrome better than traditional analyte screening. Researchers used the novel combination technique to detect these aneuploidies in 67% of 55 maternal samples, whereas the analyte test yielded only a 58% detection rate. The new test may eventually become an alternative to amniocentesis in women over 35 years old.

Trisomy, Aneuploidy

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