Umbilical cord blood sampling - A tool for delivery quality control?

Background. Regular cord blood analysis post partum is regarded by many as one of the most accurate and objective methods of auditing intrapartum care. Emergency cesarean sections and ventouse deliveries, due to the threat of asphyxia, are examples where post partum acid base data from the umbilical artery ought to be a must. The possibility of having cord blood analyses as a routine at all deliveries was investigated in this study. Methods. During a two month period blood samples were drawn from both the umbilical artery and vein at all vaginal deliveries and cesarean sections between 8 am and 4 pm. Samples were analysed for a complete acid base status and lactate concentration. Result. True paired artery-venous samples for acid base data and lactate concentrations were obtained from 48% of the women. Sampling was especially difficult after emergency cesarean section and vaginal twin deliveries. Lactate analyses gave the same information about the metabolic state of the newborn as did BEecf. Conclusions. Cord blood acid base data are a superior method of retrospective analyses of CTG-tracings and partographs within a quality control program relating to intra partum care. However, routines for cord blood sampling must be well established in both the delivery room and in the operating theater to obtain samples from the umbilical artery in cases of threatening intrapartum asphyxia. A graph for easy post partum documentation and interpretation of acid base data is introduced.