Role of Umbilical Cord Blood Gas and Lactate Analysis in Perinatal Care
A baby’s blood gas measurement is widely recognised as the best method to identify asphyxia at birth. In 2002, umbilical cord gas screening was introduced for all births at King Edward Memorial Hospital for Women. A recent study of all births between 2003 and 2008, conducted by our group, has found marked improvements in outcomes over this time. Blood gas results have improved over this time; fewer babies have gases indicative of severe asphyxia and fewer babies are being admitted to the special care nurseries for signs of birth asphyxia. We have suggested that the immediate availability of objective measurements of newborn well-being may be partially responsible for these improvements.
Until recently, universal cord gas screening had only been introduced to KEMH, which is a specialised obstetric hospital. It was not known whether introducing this technology to other less specialised hospitals would result in similar improvements.The current project is in the final stages of investigating the impact of introducing measurement of cord blood gas and lactate levels at delivery into metropolitan and regional obstetric units throughout Western Australia.
Further, we are seeking to develop a greater understanding of how best to introduce such a program into maternity units and to determine the costs and benefits of using this technology at all births.
Currently, the project is focussing on a number of key areas associated with cord blood gas and lactate analysis and utilisation. Firstly, we have compared umbilical cord blood gas and/or lactate values with traditional measurements such as the Apgar scores in order to predict early adverse neonatal outcomes. Following on from this, we have developed a number of simple and effective methods of predicting adverse neonatal outcomes that can be easily and rapidly applied to identify babies who could benefit from the emerging neuroprotective therapies.
Secondly, we have completed and published a study, which has identified the optimal manner to collect and store umbilical cord blood prior to analysis in order to minimise changes in blood gas and lactate values. Thirdly, we have conducted the first economic evaluation of the costs associated with the introduction of universal umbilical cord blood gas analysis.
The costs of umbilical cord blood gas analysis have been compared with the potential savings associated with the reduction in neonatal nursery admissions noted to follow introduction of universal analysis, with the savings found to have exceeded the costs.
Work resulting from this project has been presented at a number of local, national, and international clinical and academic conferences in Australia, Canada and the United States of America. Additionally, publications associated with this project have been published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, British Journal of Obstetrics
and Gynaecology, Journal of Maternal, Fetal and Neonatal Medicine as well as in the Thirteenth Perinatal Morbidity and Mortality Report of Health Department, Western Australia.
Mr Christopher White
Assoc Prof Craig Pennell
PhD FRANZCOG CMFM
Assoc Prof Paul McGurgan
MB BCh FRANZCOG
Prof (Adj) Dorota Doherty
BSc (Hons) PhD
Withrop Prof John Newnham
AM MD FRANZCOG
Western Australian Department of Health
The University of Western Australia