Parameters of neonate serum acid-base state and gas composition in multifetal pregnancy
https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.175
Abstract
Aim: to study ABS parameters, blood gas composition and complete blood count in newborns upon multiple pregnancy depending on the order of twin birth, neonate weight, and accompanying chronic hypoxia.
Materials and Methods. Laboratory parameters assessed in the twin-collected venous blood were analyzed: hemoglobin (Hb) and hematocrit (Ht) level, count of red blood cells (RBC), platelets (PLT) and white blood cells (WBC), base excess (BЕ), partial pressure of oxygen (рО2) and carbon dioxide (рСО2), оxygen saturation (sО2), standard and total carbon dioxide level (НСО–3, tСО2).
Results. The second vs. first twin after vaginal delivery had decreased level of рН (7.30 ± 0.08 and 7.35 ± 0.09; р = 0.03, respectively), рО2 (18.2 ± 13.1 and 27.1 ± 10.7 mm Hg; р = 0.03), sО2 (29.7 ± 22.7 and 41.8 ± 20.3 %; р < 0.001). Metabolic acidosis exacerbated in case of birth interval extending more than 30 minutes. The hypotrophic vs. normotrophic neonates had a decreased WBC (14.2 ±5.9 vs. 15.9 ± 6.5×109/L; р = 0.02), рО2 (19.3 ± 13.6 vs. 22.6 ± 10.6 mm Hg; р = 0.03), sО2 (27.9 ± 19.5 vs. 33.8 ± 20.6 %; р = 0.04). PH and PLT level were lower in newborns with intraventricular hemorrhages (7.29 ± 0.07 and 243.1 ± 75.4×109/L), whereas ВЕ magnitude was higher (–4.9 ± 5.2 mmol/L) than in those lacking intraventricular hemorrhages (7.34 ± 0.06; р = 0.03; 265.4 ±71.6×109/L; р < 0.001; –3.2 ± 4.2 mmol/L; р = 0.02, respectively).
Conclusion. During the vaginal delivery, a birth interval should not exceed 30 minutes. In case of diagnosing fetal growth retardation and hypoxia during pregnancy, caesarean section is an optimal option.
About the Author
S. A. Kalashnikov
Pirogov Russian National Research Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Sergey A. Kalashnikov – MD, PhD, Associate Professor, Department of Obstetrics and Gynecology, Faculty of Pediatrics
1 Ostrovityanova Str., Moscow 117997
References
1. Kovalenko T.S., Chechneva M.A., Kapustina M.V. et al. Isthmic-cervical insufficiency in multiple pregnancies. [Istmiko-cervikal'naya nedostatochnost' pri mnogoplodnoj beremennosti]. Rossijskij vestnik akushera-ginekologa. 2018;1(18):44–50. (In Russ.). https://doi.org/10.17116/rosakush201818144-50.
2. Abdelhafez M.S., Abdelrazik M.M., Badawy A. Early fetal reduction to twin versus prophylactic cervical cerclage for triplet pregnancies conceived with assisted reproductive techniques. Taiwan J Obstet Gynecol. 2018;57(1):95–9. https://doi.org/10.1016/j.tjog.2017.12.016.
3. Sichinava L.G. Current approaches to management of multiple pregnancies. [Mnogoplodie. Sovremennye podhody k taktike vedeniya beremennosti]. Akusherstvo, Ginekologia i Reprodukcia. 2014;2(8):131–8. (In Russ.).
4. Savelyeva G.M. My view on the current state of obstetrics and perinatology. [Moj vzglyad na sovremennoe sostoyanie akusherstva i perinatologii]. Rossijskij vestnik akushera-ginekologa. 2019;19(2):7–13. (In Russ.). https://doi.org/10.17116/rosakush2019190217.
5. Kamath M.S., Antonisamy B., Selliah H.Y., Sunkara S.K. Perinatal outcomes of singleton live births with and without vanishing twin following transfer of multiple embryos: analysis of 113 784 singleton live births. Hum Reprod. 2018;33(11):2018–22. https://doi.org/10.1093/humrep/dey284.
6. Lindroos L., Elfvin A., Ladfors L., Wennerholm U.B. The effect of twinto-twin delivery time intervals on neonatal outcome for second twins. BMC Pregnancy Childbirth. 2018;18(1):36. https://doi.org/10.1186/s12884-018-1668-6.
7. Konar H., Sarkar M., Paul J. Perinatal outcome of the second twin at a Tertiary Care Center in India. J Obstet Gynaecol India. 2016;66(6):441–7. https://doi.org/10.1007/s13224-015-0724-7.
8. Barrett J.F., Hannah M.E., Hutton E.K. et al.; Twin Birth Study Collaborative Group. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med. 2013;369(14):1295–305. https://doi.org/10.1056/NEJMoa1214939.
9. Axelsdóttir Í., Ajne G. Short-term outcome of the second twin during vaginal delivery is dependent on delivery time interval but not chorionicity. J Obstet Gynaecol. 2019;39(3):308–12. https://doi.org/10.1080/01443615.2018.1514490.
10. Suh Y.H., Park K.H., Hong J.S. et al. Relationship between twin-to-twin delivery interval and umbilical art ery acid-base status in the second twin. J Korean Med Sci. 2007;22(2):248–53. https://doi.org/10.3346/jkms.2007.22.2.248.
11. Stein W., Misselwitz B., Schmidt S. Twin-to-twin delivery time interval: influencing factors and effect on short-term outcome of the second twin. Acta Obstet Gynecol Scand. 2008;87(3):346–53. https://doi.org/10.1080/00016340801934276.
12. Lukanskaya E.N. The parameters of acid-base composition and concentration of blood glucose in the vessels of the umbilical cord with chronic hypoxia of fetus after operative delivery. [Parametry kislotnoosnovnogo sostava i koncentracii glyukozy krovi v sosudah pupoviny pri hronicheskoj gipoksii ploda posle operativnogo rodorazresheniya]. Tihookeanskij medicinskij zhurnal. 2014;(4):67–71. (In Russ.).
13. Algeri P., Callegari C., Bernasconi D.P. et al. Neonatal hypoxia of the second twin after vaginal delivery of the first twin: what matters? J Matern Fetal Neonatal Med. 2019;32(17):2889–96. https://doi.org/10.1080/14767058.2018.1451510.
14. Cnattingius S., Johansson S., Razaz N. Associations between metabolic acidosis at birth and reduced Apgar scores within the normal range (7–10): A Swedish cohort study of term non-malformed infants. Paediatr Perinat Epidemiol. 2020;34(5):572–80. https://doi.org/10.1111/ppe.12663.
15. Santotoribio J.D., Cañavate-Solano C., Quintero-Prado R. et al. Neuroapoptosis in newborns with respiratory acidosis at birth. Clin Biochem. 2019;74:69–72. https://doi.org/10.1016/j.clinbiochem.2019.08.013.
16. Kikuchi H., Noda S., Katsuragi S. et al. Evaluation of 3-tier and 5-tier FHR pattern classifications using umbilical blood pH and base excess at delivery. PLoS One. 2020;15(2):0228630. https://doi.org/10.1371/journal.pone.0228630.
17. Kiriakov K.S., Khatagova R.B., Trizna E.V. et al. Correction of the acidbase balance in the presence of the hypoxic-ischemic brain damage in newborns. [Korrekciya kislotno-osnovnogo sostoyaniya pri gipoksicheski-ishemicheskom porazhenii golovnogo mozga u novorozhdennyh]. Rossijskij vestnik perinatologii i pediatrii. 2018;63(1):40–5. (In Russ.). https://doi.org/10.21508/1027-4065-2018-63-1-40-45.
18. Prikhodko A.M., Romanov A.Yu., Shuklina D.A., Baev O.R. The indicators of acid-base balance and the gas composition of umbilical cord arterial and venous blood in health and fetal hypoxia. [Pokazateli kislotno-osnovnogo ravnovesiya i gazovyj sostav arterial'noj i venoznoj pupovinnoj krovi v norme i pri gipoksii ploda]. Akusherstvo i ginekologiya. 2019;(2):93–7. (In Russ.). https://doi.org/https://dx.doi.org/10.18565/aig.2019.2.93-97.
19. De Bernardo G., De Santis R., Giordano M. et al. Predict respiratory distress syndrome by umbilical cord blood gas analysis in newborns with reassuring Apgar score. Ital J Pediatr. 2020;46(1):20. https://doi.org/10.1186/s13052-020-0786-8.
20. Kinzhalova S.V., Makarov R.A., Bychkova S.V. et al. Features of early neonatal adaptation in infants born to mothers with hypertensive disorders of pregnancy. [Osobennosti rannej neonatal'noj adaptacii novorozhdennyh ot materej s arterial'noj gipertenziej pri beremennosti]. Rossijskij vestnik perinatologii i pediatrii. 2016;61(6):54–8. (In Russ.). https://doi.org/10.21508/1027-4065-2016-61-6-54-58.
21. Bjelic-Radisic V., Pristauz G., Haas J. et al. Neonatal outcome of second twins depending on presentation and mode of delivery. Twin Res Hum Genet. 2007;10(3):521–7. https://doi.org/10.1375/twin.10.3.521.
22. Blitz M.J., Rochelson B., Benja-Athonsirikul N. et al. Effect of chorionicity on umbilical cord blood acid-base analysis of the second twin. Twin Res Hum Genet. 2020;23(3):178–83. https://doi.org/10.1017/thg.2020.10.
23. McGrail C.D., Bryant D.R. Intertwin time interval: how it affects the immediate neonatal outcome of the second twin. Am J Obstet Gynecol. 2005;192(5):1420–2. https://doi.org/10.1016/j.ajog.2005.02.079.
24. Zelenko E.N., Voskresensky S.L., Shishko G.A. et al. Parameters of ABS and oxygen status of umbilical cord blood during physiological childbirth. [Parametry KOS i kislorodnogo statusa krovi pupoviny pri fiziologicheskih rodah]. Ohrana materinstva i detstva. 2012;(1):45–8. (In Russ.).
25. Green D.W., Elliott K., Mandel D. et al. Neonatal nucleated red blood cells in discordant twins. Am J Perinatol. 2004;21(6):341–5. https://doi.org/10.1055/s-2004-831883.
26. Kim S.H., Kim Y.M., Sung J.H. et al. The effects of birth order on neonatal outcomes in early-preterm, late-preterm and term twin infants. J Matern Fetal Neonatal Med. 2020;33(12):1980–7. https://doi.org/10.1080/14767058.2018.1534954.
27. Salonvaara M., Riikonen P., Kekomäki R. et al. Effects of gestational age and prenatal and perinatal events on the coagulation status in premature infants. Arch Dis Child Fetal Neonatal Ed. 2003;88(4):F319–23. https://doi.org/10.1136/fn.88.4.f319.
28. Goswami I.R., Abou Mehrem A., Scott J. et al. Metabolic acidosis rather than hypo/hypercapnia in the first 72 hours of life associated with intraventricular hemorrhage in preterm neonates. J Matern Fetal Neonatal Med. 2019 Dec 18;1–9. https://doi.org/10.1080/14767058.2019.1701649. [Online ahead of print].
29. Guidelines for Perinatology. Disturbances of acid-base state. Ed. D.O. Ivanov. [Narusheniya kislotno-osnovnogo sostoyaniya. Rukovodstvo po perinatologii. Pod red. D.O. Ivanova]. SPb: Inform-Navigator, 2019. 1592 s. (In Russ.).
Review
For citations:
Kalashnikov S.A. Parameters of neonate serum acid-base state and gas composition in multifetal pregnancy. Obstetrics, Gynecology and Reproduction. 2020;14(6):612-621. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.175
Views:
914
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 
