Dataset Information

Does a longer second stage of labor worsen umbilical artery blood gas parameters in newborns?-a retrospective cohort study of 2,140 cases.

ABSTRACT:

Background

With the application of the new labor management model in China, the normal length of the second stage of labor is significantly longer than that of the old model. It is unclear whether a longer stage of labor worsens umbilical artery blood gas analysis (UABGA) in newborns. The aim of this study was to investigate the correlation between the second stage of labor length, UABGA results, and neonatal intensive care unit (NICU) transfer rates under the new labor management model.

Methods

This is a retrospective cohort study including full-term, cephalic, vaginal deliveries. Exclusion criteria were preterm deliveries or deliveries by cesarean section during labor. The pH, base excess (BE), and lactate results of UABGA in newborns clearly reflect neonatal metabolic acidosis and intrauterine oxygenation of the fetus. The correlation between the length of the second stage of labor and the results of UABGA and NICU transfer rate was analyzed using linear or logistic regression and curve fitting.

Results

Of the total 2,140 cases, after adjusting for maternal age, gestational week, high-risk pregnancy factors, body mass index (BMI) before pregnancy, induced delivery, oxytocin during labor stage, labor analgesia, abnormal fetal position in labor stage, vaginal device delivery, length of first labor stage, and weight of the newborn, every 1 hour increase in the length of the second stage of labor decreased the UABGA pH by 0.01 [95% confidence interval (CI): -0.02 to -0.01, P<0.001], decreased the UABGA BE by 0.66 mmol/L (95% CI: -0.84 to -0.48, P<0.001), increased the UABGA lactate level by 0.39 mmol/L (95% CI: 0.29 to 0.50, P<0.001), and increased the NICU transfer rate by 26% (95% CI: 1.07 to 1.48, P=0.005). In the stratified analysis, when the length of the second stage of labor increased from 3 to 4 or more hours, there was no significant change in UABGA pH, BE, lactate, or NICU transfer rates.

Conclusions

Under the new criteria for the management of labor stage, the length of the second stage increasing from 3 to 4 or more hours did not negatively impact newborns. Therefore, clinician should not be too worried about the longer second stage of labor worsening adverse outcomes in newborns.

SUBMITTER: Li C

PROVIDER: S-EPMC9761147 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Does a longer second stage of labor worsen umbilical artery blood gas parameters in newborns?-a retrospective cohort study of 2,140 cases.

Li Chuo C He Tiantian T Zhou Jin J Tan Zhangmin Z Zhang Peizhen P Yin Yuzhu Y

Annals of translational medicine 20221101 22

<h4>Background</h4>With the application of the new labor management model in China, the normal length of the second stage of labor is significantly longer than that of the old model. It is unclear whether a longer stage of labor worsens umbilical artery blood gas analysis (UABGA) in newborns. The aim of this study was to investigate the correlation between the second stage of labor length, UABGA results, and neonatal intensive care unit (NICU) transfer rates under the new labor management model. ...[more]

PMID: 36544635

Similar Datasets

Project description:Collateral circulation is important for cerebral perfusion in acute ischemic strokes. Monitoring the oxidation-reduction potential (ORP) may be useful to assess collateral status or treatment efficacy. The objectives of the present study were to determine if the ORP was associated with collateral circulation status in middle cerebral artery (MCA) occlusions and to identify patterns in the ORP and the collateral circulation status among patients treated with intraarterial therapy (IAT) over time. The present pilot study was nested within a prospective cohort study measuring the ORP of the peripheral venous plasma of stroke patients. The population included in the present study were patients with MCA (M1/M2) occlusions. Two ORP parameters were examined: Static ORP (sORP; mV), indicating oxidative stress, and capacity ORP (cORP; µC), indicating antioxidant reserves. Collateral status was retrospectively graded using Miteff's system as good (grade 1) or reduced (grade 2/3). Comparisons were made between collateral status groups (reduced vs. good collaterals) in all patients, within a subset including only patients who received IAT, and between thrombolysis in cerebral infraction scale score (TICI) groups (0-2a vs. 2b/3). The Fisher's exact test, Student's t-test and Wilcoxon tests were used (α<0.20). The 19 patients were categorized based on their collaterals: Good collaterals (53%) and reduced collaterals (47%). The baseline characteristics were similar with the exception that the patients with good collaterals had a lower international normalized ratio (P=0.12) and were more likely to have a stroke on the left side (P=0.18) or to have a mismatch (P=0.05). The admission sORP values were comparable (169.5 vs. 164.2 mV; P=0.65), as was admission cORP (P=0.73). When considering only the patients who received IAT (n=12), admission sORP (P=0.69) and cORP (P=0.90) were also statistically similar. On day 2, after IAT, both groups experienced a worsening in ORP measures; however, the patients with good collaterals had a significantly lower sORP (169.4 vs. 203.5 mV; P=0.02) and a higher cORP (0.2 vs. 0.1 µC; P=0.002) compared with the patients with reduced collaterals. Neither sORP nor cORP were significantly different between TICI score groups on admission or on day 2. Upon discharge, patients with a TICI of 2b-3 had a significantly better sORP (P=0.03) and cORP (P=0.12) compared with those with a TICI of 0-2a. In conclusion, upon patient admission, the ORP parameters were not significantly different between the collateral circulation status groups for MCA occlusions. The ORP parameters worsened after IAT regardless of the collateral circulation status; however, after IAT, on day 2, patients with good collaterals experienced less oxidative stress (sORP) and had higher antioxidant reserves (cORP) than patients with reduced collaterals.

Project description:Currently the use of tissue engineered small diameter vascular grafts (d< 6 mm) as substitutes in vascular reconstruction has gained significant attention by the cardiovascular surgeons. Cardiovascular disease (CVD) is among the leading causes of death, worldwide. It is estimated that more than 17 million people have been diagnosed with CVD. As vascular substitutes autologous vessels such as saphenous vein, radial and mammary arteries, are currently used. Although that these vessels are used in an autologous manner, avoiding thrombus formation and immune rejection, suitable grafts can be found in less than 40% of the patients. During the last years, synthetic polymer grafts derived either from Dacron or expanded tetrafluoroethylene (ePTFE) have been developed and applied in vascular bypass surgeries. These grafts also have received FDA approval for their use in CVD. As large diameter vascular grafts (d > 6 mm), the synthetic conduits have shown promising results. On the other hand, significant adverse reactions have been reported, when are used as small diameter vascular grafts (SDVGs, d< 6 mm). The most important adverse reaction is the low patency rate that is observed, within the first year of implantation (< 70%). The lack of the endothelium layer makes these grafts susceptible to platelets aggregation and thrombus formation. Also, mismatch compliance could result to intima hyperplasia, activation of Th1/ Th2 response, calcification and overall graft failure. Taking into consideration the above data, alternative sources of SDVGs must be established. In this way, the human umbilical arteries (hUAs) may represent significant candidates for SDVGs development. HUAs, are muscular arteries, responsible for transportation of non-oxygenated blood from the fetus to mother. Their inner diameter is approximately 2-4 mm, while their length can be varied and it is dependent to the length of the human umbilical cord (hUC) . The length of a typical hUC is 30- 60 cm. HUAs can be isolated non-invasively from the hUC, a material which is discarded after the gestation. These muscular arteries are characterized by three distinct layers, tunica intima, media and adventitia, where specific cellular populations such as endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) are located. Decellularization approach, a tissue engineering method, can be applied in hUAs, in order acellular non-imunogenic SDVGs to be developed. Decellularization approach uses a combination of physical, chemical and enzymatic methods, to remove the cellular populations, while at the same time preserve the extracellular matrix (ECM) and tissue’s ultrastructure. Then, these vascular conduits can be repopulated with recipient’s ECs and VSMCs, in order to be fully compatible and functional. The aim of the current project is mainly focused to the proteomic identification and characterization of hUAs, before and after the application of the decellularization approach. The preservation of the ECM proteins like collagen, fibronectin, laminin in the decellularized hUAs, are of major importance for their key mechanical and functional properties. Until date, only a few studies have performed a broad proteomic approach in decellularized SDVGs such as the hUAs. Also, the proteomic data will be compared with the histological, biochemical and biomechanical analysis results. For this project, the hUAs were isolated from the delivered human umbilical cords to Hellenic Cord Blood Bank (HCBB) of Biomedical Research Foundation Academy of Athens (BRFAA). Human umbilical cords were obtained from end term gestations (38-40 weeks), either with normal or caesarian delivery. Each hUC was accompanied by signed informed consent by the mother before the gestation. The informed consent was in accordance with the Helsinki declaration and fulfilled the ethical standards of the Greek National Ethical Committee. After the isolation of hUAs, the decellularization approach was performed. Specifically, the hUAs were incubated in decellularization buffer 1 (DB1), consisted of 8 mM CHAPS, 1 M NaCl and 25 mM EDTA in PBS 1x, for 12 hours (h) at room temperature (RT). Briefly washes of hUAs for removal of the excess of DB1 with PBS 1x, was performed. Then, the hUAs were placed in DB2, consisted of 1.8 mM SDS, 1 M NaCl and 25 mM EDTA in PBS 1x for another 12 h at RT, followed by briefly washes with PBS 1x. Finally, the hUAs were incubated at 37o C for 12 h in α-Μinimum Essentials Medium (α-ΜΕΜ) with 40% v/v Fetal Bovine Serum (FBS), ensuring the complete removal of genetic material remnants. To evaluate the impact of the current decellularization protocol in hUAs, histological analysis, biochemically, biomechanically evaluation and full spectrum proteomic analysis were performed.

Dataset Information

Does a longer second stage of labor worsen umbilical artery blood gas parameters in newborns?-a retrospective cohort study of 2,140 cases.

Background

Methods

Results

Conclusions

Publications

Does a longer second stage of labor worsen umbilical artery blood gas parameters in newborns?-a retrospective cohort study of 2,140 cases.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets