Umbilical arterial pH in patients with cerebral palsy

Abstract

Background: Umbilical arterial pH (UApH) in severe cerebral palsy (CP) is not fully understood.

Aims: This work aims to determine the relationship between fetal acidemia and clinical features of severe CP.

Study design: A retrospective study design is used.

Subjects: A review was conducted unti1 April 2013 among 218 infants with CP diagnosed to be caused by antenatal and/or intrapartum conditions determined by the Japan Council for Quality Health Care. After excluding patients in whom the causes of CP were thought to be due to events after delivery, 168 infants born at over 34weeks of gestation that both Apgar score and UApH were measured were selected.

Outcome measures: Severe fetal acidemia was defined as a pH of less than 7.0.

Results: Six major factors were found to be associated with CP: placental abruption (A, n=42), traumatic delivery with an abnormal FHR pattern (B, n=29), an abnormal FHR pattern during labor (C, n=27), chorioamnionitis with an abnormal FHR pattern (D, n=17), an abnormal FHR pattern before labor (E, n=14), and cord prolapse (F, n=10). The UApH was less than 7.0 in 114 cases (67.9%) and more than 7.20 in 20 cases (11.9%). The UApH values were lowest in group A (median 6.7, 6.43-6.99) and highest in group E (7.18, 6.92-7.45). The distribution of the UApH values was significantly different in these groups.

Conclusion: Placental abruption was a factor most associated with low pH. Even among the infants with severe CP, over 10% of patients exhibited a non-acidemic status at birth.

Keywords: Cerebral palsy; Chorioamnionitis; Intraparum hypoxic event; Placental abruption; Umbilical arterial pH.