Examination of Systole/Diastole Ratio of Umbilical Artery in the third Trimester Gestational Pregnancy and its Correlation with Lactate Acid Level in Fetal Cord
DOI:
https://doi.org/10.3889/oamjms.2020.4071Keywords:
Lactic acid levels, S/D umbilical artery ratio, Prenatal Care, UltrasoundAbstract
BACKGROUND: Fetal distress is a serious complication of perinatal infants and refers to fetal hypoxia in the uterus and asphyxia immediately after the baby is born. The occurrence of uteroplacental disorders is related to various factors, including maternal and fetal factors. When fetal distress occurs, umbilical cord blood flow and fetal blood flow decrease, which in turn causes fetal circulation and respiratory dysfunction in the womb. Evaluating cord blood flow characteristics with ultrasound can provide a reference for prediction and diagnosis of fetal distress, especially by conducting an ultrasound examination of the Doppler S/D ratio of the umbilical arteries especially at gestational age >30 weeks.
OBJECTIVE: The objective of the study was to assess the correlation between umbilical artery SD ratio examinations with lactate acid levels in the umbilical
METHODS: This study was an observational analytic study with a cross-sectional study design. The research was conducted in Haji Adam Malik General Hospital Medan and Satellite Hospital. The sample was pregnant women who meet the inclusion and exclusion criteria, we found 38 of pregnant women from January to December 2019.
Results: The average age of patients in this study was 30 (5) years, the majority of multiparous patients were 25 (47.2), the average gestational age was 38 (2) weeks. Most births in this study were SC 38 (71.7) with an average S/D ratio in the study of 2.81 (0.52) and a mean lactic acid level of 2.7 (0.4). The average Apgar score in this study was 8/9 as many as 29 (54.7), the average S/D ratio is obtained with the average Apgar score of the patient. From this study, it is known that the higher the Apgar score, the higher the average S/D ratio value in patients. The mean patients with poor Apgar outcomes (5/6) have an S/D ratio of 2.5. From the analysis using ANNOVA also obtained p < 0.28. This shows that there is no significant relationship between Apgar score and S/D ratio. Increasing in lactic acid was found in infant outcomes with an Apgar score of 9/10 with a mean value of 2.9 (0.5). From the ANNOVA analysis, a p = 0.99 was also found. This showed that there was no significant relationship between the levels of lactic acid and Apgar score for infants. Lactic acid has a very weak positive correlation with Apgar score for infants with an R value of 0.274 (p = 0.047), this shows that lactic acid does not have a strong relationship with infant outcomes.
CONCLUSION: There was no correlation between umbilical cord S/D ratio and lactic acid with Apgar score. Lactic acid has a very weak positive correlation with the infant Apgar score with an R value of 0.274.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Adanikin AI, Awoleke JO. Clinical suspicion, management and outcome of intrapartum foetal distress in a public hospital with limited advanced foetal surveillance. J Matern Fetal Neonatal Med. 2017;30(4):424-9. https://doi.org/10.1080/14767058.2016.1174991 PMid:27050656
Kolnik N, Strauss T, Globus O, Leibovitch L, Schushan-Eisen I, Morag I, et al. Risk factors for periventricular echodensities and outcomes in preterm infants. J Matern Fetal Neonatal Med. 2017;30(4):397-401. https://doi.org/10.1080/14767058.2016.11 74684 PMid:27046804
Haşmaşanu MG, Bolboaca SD, Drugan TC, Matyas M, Zaharie GC. Parental factors associated with intrauterine growth restriction. Srp Arh Celok Lek. 2015;143(11-12):701-6. https://doi.org/10.2298/sarh1512701h PMid:26946765
Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. ACOG committee opinion. Number 326, December 2005. Inappropriate use of the terms fetal distress and birth asphyxia. Obstet Gynecol. 2005;106(6):1469- 70. https://doi.org/10.1097/00006250-200512000-00056 PMid:16319282
Yulifah R, dan Yuswanto TJ. Asuhan Kebidanan Komunitas. Jakarta: Salemba Medika; 2009.
Mendes RF, Martinelli S, Bittar RE, Francisco RP, Zugaib M. Relation between nucleated red blood cell count in umbilical cord and the obstetric and neonatal outcomes in small for gestational age fetuses and with normal doppler velocimetry of umbilical artery. Rev Bras Ginecol Obstet. 2015;37(10):455-9. https://doi.org/10.1590/so100-720320150005271 PMid:26313882
Akolekar R, Syngelaki A, Gallo DM, Poon LC, Nicolaides KH. Umbilical and fetal middle cerebral artery Doppler at 35-37 weeks’ gestation in the prediction of adverse perinatal outcome. Ultrasound Obstet Gynecol. 2015;46(1):82-92. https:// doi.org/10.1002/uog.14842 PMid:25779696
Frauenschuh I, Wirbelauer J, Karl S, Girschick G, Rehn M, Zollner U, et al. Prognostic factors of perinatal short-term outcome in severe placental insufficiency using Doppler sonography to assess end-diastolic absent and reverse blood flow in umbilical arteries. Z Geburtshilfe Neonatol. 2015;219(1):28-36. https:// doi.org/10.1055/s-0034-1394387 PMid:25734475
Wei D, Xu Y, Ma X, Zhang L, Zhu M. Ultrasonic characteristics and clinical significance of umbilical cord blood flow in acute fetal distress. J Acute Dis. 2016;5(6):483-7. https://doi.org/10.1016/j. joad.2016.07.003
Ensing S, Abu-Hanna A, Roseboom TJ, Repping S, van der Veen F, Mol BW, et al. Risk of poor neonatal outcome at term after medically assisted reproduction: A propensity score-matched study. Fertil Steril. 2015;104(2):384-90. https://doi. org/10.1016/j.fertnstert.2015.04.035 PMid:26028279
Soothill PW, Nicolaides KH, Rodeck CH, Campbell S. Effect of gestational age on fetal and intervillous blood gas and acid-base values in human pregnancy. Fetal Ther. 1986;1(4):168-75. https://doi.org/10.1159/000262264 PMid:3454532
Gomella TL. Perinatal asphyxia. In: Gomella TL, Cunningham MD, Eyal FG, editors. Neonatology: Management, Procedures, On-call Problems, Diseases, and Drugs. 6th ed. New York: McGraww-Hill; 2009. p. 624-35.
Hecher K, Hackeloer BJ. Cardiotocogram compared to Doppler investigation of the fetal circulation in the premature growth-retarded fetus: Longitudinal observations. Ultrasound Obstet Gynecol. 1997;9(3):152-61. https://doi. org/10.1046/j.1469-0705.1997.09030152.x PMid:9165678
Kosim MS. Gangguan napas pada bayi baru lahir. In: Kosim MS, Yunanto A, Dewi R, Sarosa G, Usman A, editors. Buku Ajar Neonatologi. Jakarta: IDAI; 2008. p. 126-45.
Manoe V, Amir I. Gangguan fungsi multi organ pada bayi asfiksia berat. Sari Pediatr. 2005;5(2):72-8. https://doi.org/10.14238/ sp5.2.2003.72-8
Orozco-Gregorio H, Mota-Rojas D, Alonso-Spilsbury M, González-Lozano M, Trujillo-Ortega M, Olmos-Hernández S, et al. Importance of blood gas measurements in perinatal asphyxia and alternatives to restore the acid base balance status to improve the newborn performance. Am J Biochem Biotechnol. 2007;3(3):131-40. https://doi.org/10.3844/ajbbsp.2007.131.140
Horne M, Heit U, Swearingen H. Pocket Guide to Fluid, Electrolyte, and Acid-base Balance. Missouri: Mosby-Year Book Inc.; 1997.
Smith J, Wells L, Dodd K. The continuing fall in incidence of Hypoxic-ischaemic encephalopathy in term infants. BJOG. 2000;107(4):461-6. https://doi. org/10.1097/00006254-200010000-00010 PMid:10759262
Vintzileos A, Nochimson D, Guzman E, Knuppel R, Lamke M, Schifrin B. Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: A meta-analysis. Obstet Gynecol. 1995;85(1):149-55. https://doi. org/10.1016/0029-7844(94)00320-d PMid:7800313
Goodwin TM, Milner-Masterson L, Paul RH. Elimination of fetal scalp blood sampling on a large clinical service. Obstet Gynecol. 1994;83(6):971-4. https://doi. org/10.1097/00006250-199406000-00015 PMid:8190443
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2020 Sarma Nursani Lumbanraja, Muhammad Rizki Yasnil, Andre Marolop Pangihutan Siahaan (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0