| Objective:To study the related factors of umbilical artery blood PH in full-term newborns delivered via vagina.Method:A retrospective analysis of 304 full-term singleton pregnant women undergoing vaginal delivery in the obstetrics department of the Affiliated Hospital of Binzhou Medical College.All of the cases were collected for umbilical arterial blood analysis after birth.According to the abnormality of umbilical artery blood PH value,all the cases were divided into two groups.Cases of PH<7.15 were brought into the acidosis group(n=32),whereas cases of PH>7.15 were brought into the normal group(n=272).The related factors that may affect the PH value of umbilical artery blood were analyzed statistically,such as parity,prenatal body mass index grade,the duration of second stage of labor,neonatal birth weight,meconium stained amniotic fluid,combined gestational diabetes mellitus,fetal heart rate monitoring during labor and so on.First of all,the above factors were analyzed by independent sample t-test and chi-square test,and the statistically significant factors were analyzed by muti-factor logistic regression analysis.The independent risk factors or protective factors for pH were obtained according to OR and 95%CI.Result:1、The pH value、PaO2、HCO3-and SaO2 in the acidosis group were lower than those of the normal PH group(7.11 ±0.03 vs 7.31 ±0.05,17.97±4.31 vs 26.4±6.58,16.4±1.88 vs 19.62±1.84,32.91 ± 13.84 vs 63.01 ±30.91),while PaCO2 and Lac in the acidosis group were higher than those in the normal PH group(55.88±7.80 vs 41.6±6.37,5.68±1.10 vs 3.76±1.02),the differences were statistically significant(P<0.001).2、The incidences of neonatal asphyxia,neonatal hyperbilirubinemia,neonatal hypoglycemia,neonatal hypoxic ischemic encephalopathy and neonatal referral pediatrics in the acidosis group were higher than those in the normal PH group(21.88%vs 0%,31.25%vs 15.44%,21.88%vs 6.99%,6.25%vs 0%,28.13%vs 5.15%),the differences were statistically significant(P<0.05).3、In the univariate analysis,there were statistically significant for the duration of second stage of labor,total time of labor,prenatal body mass index grade,fetal heart monitoring during labor,combined gestational diabetes mellitus,and meconium stained amniotic fluid between the acidosis group and the normal PH value group(P<0.05).4、The results of multivariate logistic regression analysis showed that the duration of the second stage of labor(OR=0.429,95%CI=0.231-0.795)was the independent protective factor of umbilical artery blood PH.Prenatal overweight(OR=3.581,95%CI=1.204-10.648),prenatal obesity(OR=3.430,95%CI=1.268-9.282),suspicious fetal heart rate monitoring during labor(OR=7.247,95%CI=1.181-44.463),combined gestational diabetes mellitus(OR=4.283,95%CI=1.713-10.706),meconium stained amniotic fluid(OR=3.981,95%CI=1.236-12.824)were independent risk factors of umbilical artery blood PH.Conclusions:Controlling BMI before pregnancy and excessive weight gain during pregnancy,shortening the duration of the second stage of labor,correctly identify the pattern of type Ⅱ fetal heart monitoring and finish the delivery through vaginal delivery or cesarean section as soon as possible,terminating pregnancy at the right time,strictly controlling blood glucose in patients with gestational diabetes mellitus,closely monitoring the labor process of patients with meconium stained amniotic fluid are of great significance to prevent neonatal acidosis and reduce the occurrence of neonatal adverse outcomes. |
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