Implementation of universal umbilical cord pH analysis in Denmark. A national register‐based study
Abstract Introduction Umbilical cord blood gas analysis provides information about intrapartum hypoxia and is considered an important measure of quality in maternity care. Universal measurement of umbilical cord pH (UC‐pH), as part of umbilical cord blood gas analysis, has been recommended in Denmar...
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Wiley
2023-07-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14572 |
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| author | Charlotte B. Andersson Line Thellesen Ulrik S. Kesmodel Jesper P. Petersen Søren P. Johnsen |
| author_facet | Charlotte B. Andersson Line Thellesen Ulrik S. Kesmodel Jesper P. Petersen Søren P. Johnsen |
| author_sort | Charlotte B. Andersson |
| collection | DOAJ |
| description | Abstract Introduction Umbilical cord blood gas analysis provides information about intrapartum hypoxia and is considered an important measure of quality in maternity care. Universal measurement of umbilical cord pH (UC‐pH), as part of umbilical cord blood gas analysis, has been recommended in Denmark since 2009. The recommendation is that UC‐pH is measured from the umbilical cord artery (pHUA) and vein (pHUV). The aim of this study was to evaluate the national implementation of universal measurement of UC‐pH. Material and methods The study consisted of two parts. First, an evaluation of the implementation, that is, the proportion of births with measured UC‐pH since the recommendation was introduced. Second, an evaluation of the cases in which UC‐pH was missing. This analysis only involved births with gestational age ≥35 + 0 weeks. Results In the period 2009 to 2018 there were 560 889 singleton, live births with registered gestational age in Denmark. The proportion of births with measured pHUA and pHUV increased from 12.4% in 2009 to 82.8% in 2015 and then declined to 76.9% in 2018 (p < 0.001). When comparing the group with missing pH from one or both vessels to the group with both pHUA and pHUV we found lower occurrence of pregnancy and births complications in the first group, body mass index ≥35 (unadjusted RR: 0.89, 95% CI: 0.85–0.93), pregnancy induced medical conditions (RR: 0.86, 95% CI: 0.84–0.89), fetal distress during birth (RR: 0.77, 95% CI: 0.76–0.79), emergency cesarean section (RR: 0.80, 95% CI: 0.78–0.83) and serious births events (RR: 0.80, 95% CI: 0.74–0.86). In contrast, the occurrence of placental insufficiency (RR: 1.07, 95% CI: 1.03–1.11), small for gestational age (RR: 1.36, 95% CI: 1.30–1.43, for <2.3th percentile), hypothermia treatment (RR: 1.60, 95% CI: 1.21–2.14) and neonatal death (RR: 1.96, 95% CI: 1.40–2.74) were higher in the group without measured pHUA and pHUV. Conclusions The use of UC‐pH measurement has increased markedly in Denmark since universal measurement was recommended in 2009. Missing UC‐pH from one or both vessels was associated with less complicated pregnancies and with small for gestational age, hypothermia treatment and neonatal death. |
| format | Article |
| id | doaj-art-13f9d3d6ef964f3aaf1e0c5a28ca28c6 |
| institution | DOAJ |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2023-07-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-13f9d3d6ef964f3aaf1e0c5a28ca28c62025-08-20T03:22:21ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122023-07-01102785486410.1111/aogs.14572Implementation of universal umbilical cord pH analysis in Denmark. A national register‐based studyCharlotte B. Andersson0Line Thellesen1Ulrik S. Kesmodel2Jesper P. Petersen3Søren P. Johnsen4Danish Center for Health Services Research, Department of Clinical Medicine Aalborg University Gistrup DenmarkDepartment of Obstetrics and Gynecology Herlev Hospital, University of Copenhagen Herlev DenmarkDepartment of Obstetrics and Gynecology Aalborg University Hospital Aalborg DenmarkDepartment of Pediatrics Aarhus University Hospital Aarhus DenmarkDanish Center for Health Services Research, Department of Clinical Medicine Aalborg University Gistrup DenmarkAbstract Introduction Umbilical cord blood gas analysis provides information about intrapartum hypoxia and is considered an important measure of quality in maternity care. Universal measurement of umbilical cord pH (UC‐pH), as part of umbilical cord blood gas analysis, has been recommended in Denmark since 2009. The recommendation is that UC‐pH is measured from the umbilical cord artery (pHUA) and vein (pHUV). The aim of this study was to evaluate the national implementation of universal measurement of UC‐pH. Material and methods The study consisted of two parts. First, an evaluation of the implementation, that is, the proportion of births with measured UC‐pH since the recommendation was introduced. Second, an evaluation of the cases in which UC‐pH was missing. This analysis only involved births with gestational age ≥35 + 0 weeks. Results In the period 2009 to 2018 there were 560 889 singleton, live births with registered gestational age in Denmark. The proportion of births with measured pHUA and pHUV increased from 12.4% in 2009 to 82.8% in 2015 and then declined to 76.9% in 2018 (p < 0.001). When comparing the group with missing pH from one or both vessels to the group with both pHUA and pHUV we found lower occurrence of pregnancy and births complications in the first group, body mass index ≥35 (unadjusted RR: 0.89, 95% CI: 0.85–0.93), pregnancy induced medical conditions (RR: 0.86, 95% CI: 0.84–0.89), fetal distress during birth (RR: 0.77, 95% CI: 0.76–0.79), emergency cesarean section (RR: 0.80, 95% CI: 0.78–0.83) and serious births events (RR: 0.80, 95% CI: 0.74–0.86). In contrast, the occurrence of placental insufficiency (RR: 1.07, 95% CI: 1.03–1.11), small for gestational age (RR: 1.36, 95% CI: 1.30–1.43, for <2.3th percentile), hypothermia treatment (RR: 1.60, 95% CI: 1.21–2.14) and neonatal death (RR: 1.96, 95% CI: 1.40–2.74) were higher in the group without measured pHUA and pHUV. Conclusions The use of UC‐pH measurement has increased markedly in Denmark since universal measurement was recommended in 2009. Missing UC‐pH from one or both vessels was associated with less complicated pregnancies and with small for gestational age, hypothermia treatment and neonatal death.https://doi.org/10.1111/aogs.14572birthfetal monitoringneonatologyobstetricsumbilical cord pH |
| spellingShingle | Charlotte B. Andersson Line Thellesen Ulrik S. Kesmodel Jesper P. Petersen Søren P. Johnsen Implementation of universal umbilical cord pH analysis in Denmark. A national register‐based study Acta Obstetricia et Gynecologica Scandinavica birth fetal monitoring neonatology obstetrics umbilical cord pH |
| title | Implementation of universal umbilical cord pH analysis in Denmark. A national register‐based study |
| title_full | Implementation of universal umbilical cord pH analysis in Denmark. A national register‐based study |
| title_fullStr | Implementation of universal umbilical cord pH analysis in Denmark. A national register‐based study |
| title_full_unstemmed | Implementation of universal umbilical cord pH analysis in Denmark. A national register‐based study |
| title_short | Implementation of universal umbilical cord pH analysis in Denmark. A national register‐based study |
| title_sort | implementation of universal umbilical cord ph analysis in denmark a national register based study |
| topic | birth fetal monitoring neonatology obstetrics umbilical cord pH |
| url | https://doi.org/10.1111/aogs.14572 |
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