Download PDF
Am J Perinatol 2024; 41(11): 1521-1531
DOI: 10.1055/s-0043-1772228
Original Article

Umbilical Cord Blood Gas Pairs with Near-Identical Results: Probability of Arterial or Venous Source

Denis Monneret
1   Service de Biochimie et Biologie Moléculaire, Laboratoire de Biologie Médicale Multi-Sites (LBMMS), Hospices Civils de Lyon (HCL), Lyon, France
,
Robert L. Stavis 
2   Grand Rounds Software, LLC, Bryn Mawr, Pennsylvania
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective In studies of concomitant arterial–venous umbilical cord blood gases (CAV-UBGs), approximately 10% of technically valid samples have very similar pH and/or pCO2 values and were probably drawn from the same type of blood vessel. Without a way to objectively determine the source in these cases, it has been argued that most of these same-source CAV-UBGs are venous because the vein is larger and more easily sampled than the artery. This study aimed to calculate the probability of an arterial (ProbAS) or venous source (ProbVS) of same-source CAV-UBGs in the clinically and medicolegally important pH range of 6.70 to 7.25 using a statistical predictive model based on the cord blood gas values.

Study Design Starting with a dataset of 56,703 CAV-UBGs, the ProbAS, ProbVS, and respective 95% confidence intervals (CIs) were calculated for the 241 sample pairs with near-identical pH, pCO2, and pO2 values and a pH of 6.70 to 7.25. Using a previously validated generalized additive model, the source was categorized as: Probable Arterial or Highly Probable Arterial if the ProbAS and CIs were >0.5 or >0.8, respectively; Probable Venous or Highly Probable Venous if the ProbVS and CIs were >0.5 or >0.8, respectively; or Indeterminant if the CIs encompassed ProbAS/VS = 0.5.

Results A total of 39% of the same-source CAV-UBGs were Probable Arterial, 56% were Probable Venous, and 5% were Indeterminant. However, considering samples with a pH ≤7.19, 80% were Probable Arterial and 16% were Probable Venous. Considering the Highly Probable categories, the more acidemic specimens were 9 times more likely to be arterial than venous. Similarly, CAV-UBGs with pCO2 > 8.2 kPa (62 mm Hg) or pO2 ≤ 1.9 kPa (14 mm Hg) were more likely to be in the arterial rather than the venous categories.

Conclusion Same-source CAV-UBGs in the more acidemic, hypercarbic, or hypoxemic ranges are more likely to be arterial than venous.

Key Points

  • Umbilical cord arterial/venous gases (CAV-UBGs) with similar values are thought to be mainly venous.

  • A validated statistical model was used to predict the probability an arterial or venous source.

  • CAV-UBGs with very similar values and pH >  7.19 are likely venous; however, those with pH ≤ 7.19 and/or pCO2 >  8.2 kPa and/or pO2 ≤1.9 kPa are more likely arterial.

Keywords

umbilical cord - blood gas - arterial - venous - neonatal acidemia - probability - generalized additive model - GAM

Note

This paper, in part, was presented as a poster at the 2023 Pediatric Academic Society meeting in April–May, 2023.




Publication History

Received: 22 May 2023

Accepted: 10 July 2023

Article published online:
14 August 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Papile LA, Baley JE, Benitz W. et al; Committee on Fetus and Newborn. Hypothermia and neonatal encephalopathy. Pediatrics 2014; 133 (06) 1146-1150
    CrossrefPubMedGoogle Scholar
  • 2 Neonatal Encephalopathy and Neurologic Outcome. Report of the American College of Obstetricians and Gynecologists' task force on neonatal encephalopathy, 2nd ed. Washington, DC: ACOG, AAP; 2014. Reaffirmed 2019 Accessed July 31, 2023 at: https://www.acog.org/clinical/clinical-guidance/task-force-report/articles/2014/neonatal-encephalopathy-and-neurologic-outcome
    PubMed
  • 3 Ross MG. Forensic analysis of umbilical and newborn blood gas values for infants at risk of cerebral palsy. J Clin Med 2021; 10 (08) 1676
    CrossrefPubMedGoogle Scholar
  • 4 Ross MG. Threshold of metabolic acidosis associated with newborn cerebral palsy: medical legal implications. Am J Obstet Gynecol 2019; 220 (04) 348-353
    CrossrefPubMedGoogle Scholar
  • 5 Cantu J, Szychowski JM, Li X. et al. Predicting fetal acidemia using umbilical venous cord gas parameters. Obstet Gynecol 2014; 124 (05) 926-932
    CrossrefPubMedGoogle Scholar
  • 6 Swanson K, Whelan AR, Grobman WA, Miller ES. Can venous cord gas values predict fetal acidemia?. Am J Obstet Gynecol 2017; 217 (03) 364.e1-364.e5
    CrossrefPubMedGoogle Scholar
  • 7 Johnson JW, Richards DS. The etiology of fetal acidosis as determined by umbilical cord acid-base studies. Am J Obstet Gynecol 1997; 177 (02) 274-280 , discussion 280–282
    CrossrefPubMedGoogle Scholar
  • 8 Riley RJ, Johnson JWC. Collecting and analyzing cord blood gases. Clin Obstet Gynecol 1993; 36 (01) 13-23
    CrossrefPubMedGoogle Scholar
  • 9 Martin GC, Green RS, Holzman IR. Acidosis in newborns with nuchal cords and normal Apgar scores. J Perinatol 2005; 25 (03) 162-165
    CrossrefPubMedGoogle Scholar
  • 10 Westgate J, Garibaldi JM, Greene KR. Umbilical cord blood gas analysis at delivery: a time for quality data. Br J Obstet Gynaecol 1994; 101 (12) 1054-1063
    CrossrefPubMedGoogle Scholar
  • 11 Tong S, Egan V, Griffin J, Wallace EM. Cord blood sampling at delivery: do we need to always collect from both vessels?. BJOG 2002; 109 (10) 1175-1177
    CrossrefPubMedGoogle Scholar
  • 12 White CR, Doherty DA, Henderson JJ, Kohan R, Newnham JP, Pennell CE. Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit. Aust N Z J Obstet Gynaecol 2010; 50 (04) 318-328
    CrossrefPubMedGoogle Scholar
  • 13 Kro GA, Yli BM, Rasmussen S. et al. A new tool for the validation of umbilical cord acid-base data. BJOG 2010; 117 (12) 1544-1552
    CrossrefPubMedGoogle Scholar
  • 14 Monneret D, Desmurs L, Zaepfel S, Chardon L, Doret-Dion M, Cartier R. Reference percentiles for paired arterial and venous umbilical cord blood gases: an indirect nonparametric approach. Clin Biochem 2019; 67: 40-47
    CrossrefPubMedGoogle Scholar
  • 15 Monneret D, Stavis RL. Umbilical cord blood gases: probability of arterial or venous source in acidemia. Clin Chem Lab Med 2022; 61 (01) 112-122
    CrossrefPubMedGoogle Scholar
  • 16 Hilger JS, Holzman IR, Brown DR. Sequential changes in placental blood gases and pH during the hour following delivery. J Reprod Med 1981; 26 (06) 305-307
    PubMedGoogle Scholar
  • 17 Wood SN. Generalized Additive Models: An Introduction with R. 2nd e. Chapman and Hall/CRC Press; 2017
    CrossrefGoogle Scholar
  • 18 Wood SN. ‘mgcv’: Mixed GAM Computation Vehicle with Automatic Smoothness Estimation. R package version 1.8-42 ( 2023 Accessed May 19, 2023 at: https://cran.r-project.org/web/packages/mgcv/mgcv.pdf
    PubMedGoogle Scholar
  • 19 Huisjes HJ, Aarnoudse JG. Arterial or venous umbilical pH as a measure of neonatal morbidity?. Early Hum Dev 1979; 3 (02) 155-161
    CrossrefPubMedGoogle Scholar
  • 20 Armstrong L, Stenson BJ. Use of umbilical cord blood gas analysis in the assessment of the newborn. Arch Dis Child Fetal Neonatal Ed 2007; 92 (06) F430-F434
    CrossrefPubMedGoogle Scholar
  • 21 Pomerance JJ. Interpreting Umbilical Cord Blood Gases, 2nd ed. BNMG Publishing Division; 2012: 46
    Google Scholar
  • 22 Barbieri C, Cecatti JG, Surita FG, Marussi EF, Costa JV. Sonographic measurement of the umbilical cord area and the diameters of its vessels during pregnancy. J Obstet Gynaecol 2012; 32 (03) 230-236
    CrossrefPubMedGoogle Scholar
  • 23 Moinian M, Meyer WW, Lind J. Diameters of umbilical cord vessels and the weight of the cord in relation to clamping time. Am J Obstet Gynecol 1969; 105 (04) 604-611
    PubMedGoogle Scholar
  • 24 McGrath JC, MacLennan SJ, Mann AC, Stuart-Smith K, Whittle MJ. Contraction of human umbilical artery, but not vein, by oxygen. J Physiol 1986; 380: 513-519
    CrossrefPubMedGoogle Scholar
  • 25 Eltherington LG, Stoff J, Hughes T, Melmon KL. Constriction of human umbilical arteries. Interaction between oxygen and bradykinin. Circ Res 1968; 22 (06) 747-752
    CrossrefPubMedGoogle Scholar
  • 26 White RP. Pharmacodynamic study of maturation and closure of human umbilical arteries. Am J Obstet Gynecol 1989; 160 (01) 229-237
    CrossrefPubMedGoogle Scholar
  • 27 Bogoni G, Rizzi A, Calo G, Campobasso C, D'Orleans-Juste P, Regoli D. Characterization of endothelin receptors in the human umbilical artery and vein. Br J Pharmacol 1996; 119 (08) 1600-1604
    CrossrefPubMedGoogle Scholar
  • 28 Quan A, Leung SWS, Lao TT, Man RYK. 5-hydroxytryptamine and thromboxane A2 as physiologic mediators of human umbilical artery closure. J Soc Gynecol Investig 2003; 10 (08) 490-495
    CrossrefPubMedGoogle Scholar
  • 29 Santos-Silva AJ, Cairrão E, Marques B, Verde I. Regulation of human umbilical artery contractility by different serotonin and histamine receptors. Reprod Sci 2009; 16 (12) 1175-1185
    CrossrefPubMedGoogle Scholar
  • 30 Lorigo M, Mariana M, Feiteiro J, Cairrao E. How is the human umbilical artery regulated?. J Obstet Gynaecol Res 2018; 44 (07) 1193-1201
    CrossrefPubMedGoogle Scholar
  • 31 Meyer WW, Rumpelt HJ, Yao AC, Lind J. Structure and closure mechanism of the human umbilical artery. Eur J Pediatr 1978; 128 (04) 247-259
    CrossrefPubMedGoogle Scholar
  • 32 Nandadasa S, Szafron JM, Pathak V. et al. Vascular dimorphism ensured by regulated proteoglycan dynamics favors rapid umbilical artery closure at birth. eLife 2020; 9: e60683
    CrossrefPubMedGoogle Scholar
  • 33 Wagenseil JE, Downs KM. Severing umbilical ties. eLife 2020; 9: e63128
    CrossrefPubMedGoogle Scholar
  • 34 Boere I, Roest AA, Wallace E. et al. Umbilical blood flow patterns directly after birth before delayed cord clamping. Arch Dis Child Fetal Neonatal Ed 2015; 100 (02) F121-F125
    CrossrefPubMedGoogle Scholar
  • 35 Leino A, Kurvinen K. Interchangeability of blood gas, electrolyte and metabolite results measured with point-of-care, blood gas and core laboratory analyzers. Clin Chem Lab Med 2011; 49 (07) 1187-1191
    CrossrefPubMedGoogle Scholar
  • 36 Luukkonen AA, Lehto TM, Hedberg PS, Vaskivuo TE. Evaluation of a hand-held blood gas analyzer for rapid determination of blood gases, electrolytes and metabolites in intensive care setting. Clin Chem Lab Med 2016; 54 (04) 585-594
    CrossrefPubMedGoogle Scholar
  • 37 De Koninck AS, De Decker K, Van Bocxlaer J, Meeus P, Van Hoovels L. Analytical performance evaluation of four cartridge-type blood gas analyzers. Clin Chem Lab Med 2012; 50 (06) 1083-1091
    PubMedGoogle Scholar