[ozmidwifery] Blood gasses
20061113-79# The effects of time on pH and gas values in the blood contained in the umbilical cord - Acta Obstetricia et Gynecologica Scandinavica , vol 85, no 11, 2006, pp 1307-1309 Valenzuela P; Guijarro R - (2006) Background. The pH and gas analysis of umbilical cord blood is an accepted practice in most maternity hospitals. The data that is obtained after a latency period in processing the cord blood samples is evaluated to determine whether it is useful for the clinic. Methods. The umbilical cords from 50 term infants were clamped immediately after delivery. Samples of artery and vein blood were drawn 5, 60, and 120 min postpartum and pH, pO2, and pCO2 levels were measured. Results.No significant differences were found after 60 min in the average values for pH in the arterial and venous paired samples, though the arterial and venous pCO2 values declined significantly. The arterial pO2 values increased significantly. After 120 min, no significant differences in the average values for the venous pH and pO2 paired samples were found. The arterial pH values increased significantly, however, and the arterial and venous pCO2 values declined significantly. The arterial pO2 values increased significantly. Conclusions. Though statistically significant differences occurred over time, these changes were so modest clinically that the data could still be used even when an immediate analysis of the umbilical cord was not possible. (12 references) (Author)
[ozmidwifery] Blood gasses( Long)
This Technical report covers fetal monitoring in a really comprehensive way. www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.section.700 Re blood gases, I promise not to bother you again, but still having difficulties finding recent studies. This first one appears to explain the process and meanings better than any other I have read. I excerpted some interesting points from the articles I read. MM 1. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 101:1054-1063, 1994 Umbilical Cord Blood Gas Analysis at Delivery: A Time for Quality Data. Jennifer A. Westgate, Jonathan M. Garibaldi, Keith R. Greene 2, Postpartum Determination of Umbilical Artery Blood Gases: Effect of Time and Temperature Moshe Manor, Isaac Blicksteina, Ynon Hazan, Orna Flidel-Rimon1, and Zion J. Hagay 1 Depts. of Obstet. and Gynecol. and Neonatol., Kaplan Hosp., 76100 Rehovot, Israel (affiliated with Hadassah-Hebrew Univ. School of Med., Jerusalem); a author for correspondence: fax 972-8-9411944, e-mail [EMAIL PROTECTED] Determination of cord blood gases and pH is recommended in all neonates with low Apgar scores to distinguish metabolic acidosis from hypoxemia or from other causes that might result in low Apgar scores (1). Although the metabolic acidosis found in cord blood is a poor predictor of long-term neurological injury (2), assessment of umbilical cord blood gas is helpful to exclude intrapartum or birth events that cause acidosis and serves as legal evidence against any alleged association with poor outcome (3). 3. Obstet Gynecol Clin North Am. 1999 Dec;26(4):695-709. Related Articles, Links Umbilical cord blood gas analysis. Thorp JA, Rushing RS. St. Luke's Hospital of Kansas City, Missouri, USA. Umbilical cord blood gas and pH values should always be obtained in the high-risk delivery and whenever newborn depression occurs. This practice is important because umbilical cord blood gas analysis may assist with clinical management and excludes the diagnosis of birth asphyxia in approximately 80% of depressed newborns at term. The most useful umbilical cord blood parameter is arterial pH. Sampling umbilical venous blood alone is not recommended because arterial blood is more representative of the fetal metabolic condition and because arterial acidemia may occur with a normal venous pH. A complete blood gas analysis may provide important information regarding the type and cause of acidemia and sampling the artery and vein may provide a more clear assessment. The sampling technique is simple and easily mastered by any treatment person in the delivery room. Preheparinized syringes ensure a consistent dose and amount of heparin. Depending on how normality is defined and on the population studied, normal ranges for umbilical cord blood gas values vary (see Table 1). In general, the lower range for normal arterial pH extends to at least 7.10 and that for venous pH to at least 7.20. Many different factors during pregnancy, labor, and delivery can affect cord blood gases. Umbilical blood sampling for acid-base status at all deliveries cannot be universally recommended because many facilities do not have the capabilities to support such a practice and in doing so may impose an excessive financial burden. Considering the costs, the accumulated published data, and the nonspecificity of electronic fetal monitoring in the evaluation of fetal oxygenation, it may be more rational to implement universal cord blood gas analysis. Care providers and institutions with the logistical capabilities in place should consider the cost efficacy of routine cord blood gas analysis because it is the gold standard assessment of uteroplacental function and fetal oxygenation/acid-base status at birth. 4. Umbilical Cord Blood Gas Analysis at Delivery S F Loh, A Woodworth, G S H Yeo (research carried out in 1994. MM) Umbilical cord blood gas values reflect the last moment of fetal oxygenation and acid base balance prior to delivery. Severe fetal acidemia is associated with increased perinatal mortality and increased risk of subsequent impaired neurological develop In acute hypoxic insult of short duration, fetal and placental blood may not have sufficient time to equilibrate and this may be reflected in a large arterial-venous difference in BDecf. However, in long-standing hypoxic insult, lactic acid produced by the baby was given time to be removed across the placenta to saturate the placental extracellular fluid compartment. In conclusion, we are sure that umbilical cord blood gas analysis is useful to ascertain whether a particular case of fetal compromise is due to perinatal asphyxia. Selectively paired umbilical cord blood gas analysis, when properly done and correctly interpreted offers insight into metabolic events occurring in the perinatal period and enables the obstetricians to learn from individual patient. It also provides the neonatologists with a baseline of the neonates metabolic condition. A
Re: [ozmidwifery] Blood gasses( Long)
Thanks Mary for all your effort in finding these refs. Very useful. Melissa - Original Message - From: Mary Murphy To: ozmidwifery@acegraphics.com.au Sent: Tuesday, October 24, 2006 8:06 PM Subject: [ozmidwifery] Blood gasses( Long) This Technical report covers fetal monitoring in a really comprehensive way. www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.section.700 Re blood gases, I promise not to bother you again, but still having difficulties finding recent studies. This first one appears to explain the process and meanings better than any other I have read. I excerpted some interesting points from the articles I read. MM 1. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 101:1054-1063, 1994 Umbilical Cord Blood Gas Analysis at Delivery: A Time for Quality Data. Jennifer A. Westgate, Jonathan M. Garibaldi, Keith R. Greene 2, Postpartum Determination of Umbilical Artery Blood Gases: Effect of Time and Temperature Moshe Manor, Isaac Blicksteina, Ynon Hazan, Orna Flidel-Rimon1, and Zion J. Hagay 1 Depts. of Obstet. and Gynecol. and Neonatol., Kaplan Hosp., 76100 Rehovot, Israel (affiliated with Hadassah-Hebrew Univ. School of Med., Jerusalem);a author for correspondence: fax 972-8-9411944, e-mail [EMAIL PROTECTED] Determination of cord blood gases and pH is recommended in all neonates with low Apgar scores to distinguish metabolic acidosis from hypoxemia or from other causes that might result in low Apgar scores (1). Although the metabolic acidosis found in cord blood is a poor predictor of long-term neurological injury (2), assessment of umbilical cord blood gas is helpful to exclude intrapartum or birth events that cause acidosis and serves as legal evidence against any alleged association with poor outcome (3). 3. Obstet Gynecol Clin North Am. 1999 Dec;26(4):695-709. Related Articles, Links Umbilical cord blood gas analysis. Thorp JA, Rushing RS. St. Luke's Hospital of Kansas City, Missouri, USA.Umbilical cord blood gas and pH values should always be obtained in the high-risk delivery and whenever newborn depression occurs. This practice is important because umbilical cord blood gas analysis may assist with clinical management and excludes the diagnosis of birth asphyxia in approximately 80% of depressed newborns at term. The most useful umbilical cord blood parameter is arterial pH. Sampling umbilical venous blood alone is not recommended because arterial blood is more representative of the fetal metabolic condition and because arterial acidemia may occur with a normal venous pH. A complete blood gas analysis may provide important information regarding the type and cause of acidemia and sampling the artery and vein may provide a more clear assessment. The sampling technique is simple and easily mastered by any treatment person in the delivery room. Preheparinized syringes ensure a consistent dose and amount of heparin. Depending on how normality is defined and on the population studied, normal ranges for umbilical cord blood gas values vary (see Table 1). In general, the lower range for normal arterial pH extends to at least 7.10 and that for venous pH to at least 7.20. Many different factors during pregnancy, labor, and delivery can affect cord blood gases. Umbilical blood sampling for acid-base status at all deliveries cannot be universally recommended because many facilities do not have the capabilities to support such a practice and in doing so may impose an excessive financial burden. Considering the costs, the accumulated published data, and the nonspecificity of electronic fetal monitoring in the evaluation of fetal oxygenation, it may be more rational to implement universal cord blood gas analysis. Care providers and institutions with the logistical capabilities in place should consider the cost efficacy of routine cord blood gas analysis because it is the gold standard assessment of uteroplacental function and fetal oxygenation/acid-base status at birth. 4. Umbilical Cord Blood Gas Analysis at DeliveryS F Loh, A Woodworth, G S H Yeo (research carried out in 1994. MM) Umbilical cord blood gas values reflect the last moment of fetal oxygenation and acid base balance prior to delivery. Severe fetal acidemia is associated with increased perinatal mortality and increased risk of subsequent impaired neurological develop In acute hypoxic insult of short duration, fetal and placental blood may not have sufficient time to equilibrate and this may be reflected in a large arterial-venous difference in BDecf. However, in long-standing hypoxic insult, lactic acid produced by the baby was given time to be removed across
RE: [ozmidwifery] blood gasses and other policies
Hi Barb I had a client just last week for a pregnancy massage. She is 31 weeks and this is her second child. She breasted her first bub until she was about 18 months old. However, she is TERRIFIED not about the birth but about her new baby being given formula whilst it is in hospital. Apparently, this occurred with her first baby but without her knowledge and consent. At the time, she was absolutely furious that this had occurred because she had let everyone know how very keen she was to breastfeed. When she asked why this happened, she was given a variety of different reasons ranging from baby was hungry to a mere shrug of the shoulders. She spoke to her obs about it and he did not seem to be concerned about all the fuss. She couldnt understand why no-one seemed to think it was an issue because it was for her. In fact, she got really angry while talking about it during the massage and then she started crying still upset after almost 3 years!!! Ramona Lane Nunyara Healing From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Barbara Glare Chris Bright Sent: Sunday, 15 October 2006 9:43 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] blood gasses and other policies HI, Interesting conversation about blood gasses.I frequently get reports from mothers and health professionals that they gave birth in a Baby friendly hospital, or a hospital with clear policies on breastfeeding, but that babies are given infant formula often without their parents consent, or not with their parents INFORMED consent. This always intrigues me greatly. There seem to be no repercussions for staff who go against breastfeeding policies. Reasons I have heard for staff giving babies formula when I've asked midwives why they gave a baby formula include the other midwife told me the baby was hungry, we didn't want to disturb the mother etc. Mothers tell me they were told that staff didn't want to wake/disturb the mother - they knew she was tired. Told she had no milk. Told the baby was hungry and needed something.And, my personal favourite, it's OK, at this hospital we give babies the formula that is closest to human milk Rarely are they told WHY the midwife thinks these things.These are babieswho are well, don't even start me on babies in the nursery where parent's rights seem to go right out the window.Some parents I have spoken to are very upset and angry. I wonder why breastfeeding policy is in a *different* category in most hospitals? Do others find this? Barb
RE: [ozmidwifery] blood gasses and other policies
I hope she wrote to the CEO of the hospital. She should make it VERY clear this time, in writing and I would put a big sign on the baby's cot. Is she aware that she could take legal action? The threat is usually enough. Women and midwives must take a stand because so many of the older midwives, and women still think it's ok to give a baby formula. On the other hand, a lot of mum's insist on comps even though the midwives discuss it stressing the importance of NOT giving formula. -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of nunyaraSent: Monday, 16 October 2006 6:12 PMTo: ozmidwifery@acegraphics.com.auSubject: RE: [ozmidwifery] blood gasses and other policies Hi Barb I had a client just last week for a pregnancy massage. She is 31 weeks and this is her second child. She breasted her first bub until she was about 18 months old. However, she is TERRIFIED not about the birth but about her new baby being given formula whilst it is in hospital. Apparently, this occurred with her first baby but without her knowledge and consent. At the time, she was absolutely furious that this had occurred because she had let everyone know how very keen she was to breastfeed. When she asked why this happened, she was given a variety of different reasons ranging from baby was hungry to a mere shrug of the shoulders. She spoke to her obs about it and he did not seem to be concerned about all the fuss. She couldnt understand why no-one seemed to think it was an issue because it was for her. In fact, she got really angry while talking about it during the massage and then she started crying still upset after almost 3 years!!! Ramona Lane Nunyara Healing From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Barbara Glare Chris BrightSent: Sunday, 15 October 2006 9:43 AMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] blood gasses and other policies HI, Interesting conversation about blood gasses.I frequently get reports from mothers and health professionals that they gave birth in a Baby friendly hospital, or a hospital with clear policies on breastfeeding, but that babies are given infant formula often without their parents consent, or not with their parents INFORMED consent. This always intrigues me greatly. There seem to be no repercussions for staff who go against breastfeeding policies. Reasons I have heard for staff giving babies formula when I've asked midwives why they gave a baby formula include "the other midwife told me the baby was hungry", we didn't want to disturb the mother etc. Mothers tell me they were told that staff didn't want to wake/disturb the mother - they knew she was tired. Told she had no milk. Told the baby was hungry and needed something.And, my personal favourite, "it's OK, at this hospital we give babies the formula that is closest to human milk" Rarely are they told WHY the midwife thinks these things.These are babieswho are well, don't even start me on babies in the nursery where parent's rights seem to go right out the window.Some parents I have spoken to are very upset and angry. I wonder why breastfeeding policy is in a *different* category in most hospitals? Do others find this? Barb
Re: [ozmidwifery] blood gasses and other policies
This is dreadful, This behaviour is assault and if i found someone had done that to my child I would have them charged! Di - Original Message - From: nunyara To: ozmidwifery@acegraphics.com.au Sent: Monday, October 16, 2006 6:11 PM Subject: RE: [ozmidwifery] blood gasses and other policies Hi Barb I had a client just last week for a pregnancy massage. She is 31 weeks and this is her second child. She breasted her first bub until she was about 18 months old. However, she is TERRIFIED not about the birth but about her new baby being given formula whilst it is in hospital. Apparently, this occurred with her first baby but without her knowledge and consent. At the time, she was absolutely furious that this had occurred because she had let everyone know how very keen she was to breastfeed. When she asked why this happened, she was given a variety of different reasons ranging from baby was hungry to a mere shrug of the shoulders. She spoke to her obs about it and he did not seem to be concerned about all the fuss. She couldnt understand why no-one seemed to think it was an issue because it was for her. In fact, she got really angry while talking about it during the massage and then she started crying still upset after almost 3 years!!! Ramona Lane Nunyara Healing From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Barbara Glare Chris BrightSent: Sunday, 15 October 2006 9:43 AMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] blood gasses and other policies HI, Interesting conversation about blood gasses.I frequently get reports from mothers and health professionals that they gave birth in a Baby friendly hospital, or a hospital with clear policies on breastfeeding, but that babies are given infant formula often without their parents consent, or not with their parents INFORMED consent. This always intrigues me greatly. There seem to be no repercussions for staff who go against breastfeeding policies. Reasons I have heard for staff giving babies formula when I've asked midwives why they gave a baby formula include "the other midwife told me the baby was hungry", we didn't want to disturb the mother etc. Mothers tell me they were told that staff didn't want to wake/disturb the mother - they knew she was tired. Told she had no milk. Told the baby was hungry and needed something.And, my personal favourite, "it's OK, at this hospital we give babies the formula that is closest to human milk" Rarely are they told WHY the midwife thinks these things.These are babieswho are well, don't even start me on babies in the nursery where parent's rights seem to go right out the window.Some parents I have spoken to are very upset and angry. I wonder why breastfeeding policy is in a *different* category in most hospitals? Do others find this? Barb
RE: [ozmidwifery] blood gasses and other policies
Ramona, She may have to fight tooth and nail not to let the baby out of her sight this time. Only way to make sure formula is not given. Hope she succeeds this time. Cheers Judy --- nunyara [EMAIL PROTECTED] wrote: Hi Barb I had a client just last week for a pregnancy massage. She is 31 weeks and this is her second child. She breasted her first bub until she was about 18 months old. However, she is TERRIFIED - not about the birth - but about her new baby being given formula whilst it is in hospital. Apparently, this occurred with her first baby but without her knowledge and consent. At the time, she was absolutely furious that this had occurred because she had let everyone know how very keen she was to breastfeed. When she asked why this happened, she was given a variety of different reasons ranging from baby was hungry to a mere shrug of the shoulders. She spoke to her obs about it and he did not seem to be concerned about all the fuss. She couldn't understand why no-one seemed to think it was an issue because it was - for her. In fact, she got really angry while talking about it during the massage and then she started crying - still upset after almost 3 years!!! Ramona Lane Nunyara Healing _ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Barbara Glare Chris Bright Sent: Sunday, 15 October 2006 9:43 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] blood gasses and other policies HI, Interesting conversation about blood gasses. I frequently get reports from mothers and health professionals that they gave birth in a Baby friendly hospital, or a hospital with clear policies on breastfeeding, but that babies are given infant formula often without their parents consent, or not with their parents INFORMED consent. This always intrigues me greatly. There seem to be no repercussions for staff who go against breastfeeding policies. Reasons I have heard for staff giving babies formula when I've asked midwives why they gave a baby formula include the other midwife told me the baby was hungry, we didn't want to disturb the mother etc. Mothers tell me they were told that staff didn't want to wake/disturb the mother - they knew she was tired. Told she had no milk. Told the baby was hungry and needed something. And, my personal favourite, it's OK, at this hospital we give babies the formula that is closest to human milk Rarely are they told WHY the midwife thinks these things. These are babies who are well, don't even start me on babies in the nursery where parent's rights seem to go right out the window. Some parents I have spoken to are very upset and angry. I wonder why breastfeeding policy is in a *different* category in most hospitals? Do others find this? Barb On Yahoo!7 Check back weekly for Trixi's new online adventures http://www.trixi.com.au -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] blood gasses and other policies
HI, Interesting conversation about blood gasses.I frequently get reports from mothers and health professionals that they gave birth in a Baby friendly hospital, or a hospital with clear policies on breastfeeding, but that babies are given infant formula often without their parents consent, or not with their parents INFORMED consent. This always intrigues me greatly. There seem to be no repercussions for staff who go against breastfeeding policies. Reasons I have heard for staff giving babies formula when I've asked midwives why they gave a baby formula include "the other midwife told me the baby was hungry", we didn't want to disturb the mother etc. Mothers tell me they were told that staff didn't want to wake/disturb the mother - they knew she was tired. Told she had no milk. Told the baby was hungry and needed something.And, my personal favourite, "it's OK, at this hospital we give babies the formula that is closest to human milk" Rarely are they told WHY the midwife thinks these things.These are babieswho are well, don't even start me on babies in the nursery where parent's rights seem to go right out the window.Some parents I have spoken to are very upset and angry. I wonder why breastfeeding policy is in a *different* category in most hospitals? Do others find this? Barb
Re: [ozmidwifery] blood gasses and other policies
I hear this stuff too, Barb and it concerns me greatly. I did some research on BFHI though and you don't need much to get accreditation!The attitidues you describe showvery little understanding of how bf works or how babies bf in the early days of their lives but it horrifies the crap outta me that so many get forcefed and have their guts permanently altered. I also hear of way too little support for women to bf in SCN and "minimal handling" taken to mean the staff can do whatever they like and the parents are limited!This has huge implications for those kids' health for the rest of their lives and at some point someone in govt has to notice how much it costs in the long run to ff. : ( J - Original Message - From: Barbara Glare Chris Bright To: ozmidwifery@acegraphics.com.au Sent: Sunday, October 15, 2006 9:42 AM Subject: [ozmidwifery] blood gasses and other policies HI, Interesting conversation about blood gasses.I frequently get reports from mothers and health professionals that they gave birth in a Baby friendly hospital, or a hospital with clear policies on breastfeeding, but that babies are given infant formula often without their parents consent, or not with their parents INFORMED consent. This always intrigues me greatly. There seem to be no repercussions for staff who go against breastfeeding policies. Reasons I have heard for staff giving babies formula when I've asked midwives why they gave a baby formula include "the other midwife told me the baby was hungry", we didn't want to disturb the mother etc. Mothers tell me they were told that staff didn't want to wake/disturb the mother - they knew she was tired. Told she had no milk. Told the baby was hungry and needed something.And, my personal favourite, "it's OK, at this hospital we give babies the formula that is closest to human milk" Rarely are they told WHY the midwife thinks these things.These are babieswho are well, don't even start me on babies in the nursery where parent's rights seem to go right out the window.Some parents I have spoken to are very upset and angry. I wonder why breastfeeding policy is in a *different* category in most hospitals? Do others find this? Barb
