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Áhrif eðlilegrar fæðingar á súrefnisflutning til fósturs

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Authors
Þórður Þórkelsson
Anton Örn Bjarnason
Hildur Harðardóttir

Aðalbjörn Þorsteinsson
Ásgeir Haraldsson
Atli Dagbjartsson
Issue Date
2008-09-01

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Other Titles
The effects of normal vaginal delivery on oxygen transport to the fetus
Citation
Læknablaðið 2008, 94(9):583-8
Abstract
OBJECTIVE: To evaluate the effects of normal vaginal delivery (NVD) on oxygen transport to the fetus. Study group and methods: Fifty newborn infants born by NVD and as a control group 50 infants born by elective Cesarean section (ECS) were studied. Factors reflecting oxygen transport to the fetus were measured in venous and arterial cord blood: pH, partial pressure of oxygen (pO2) and carbon dioxide (pCO2), oxygen saturation (SO2), blood oxygen content, base deficit, and lactic acid concentrations, erythropoietin concentrations, number of nucleated red blood cells and haemoglobin concentrations. RESULTS: There was no significant difference in venous blood oxygen content between the two groups of infants. However, arterial blood oxygen content was significanlty lower in the infants born by ECS than in those born by NVD (p<0.001). Infants born by NVD had significantly lower pH (p<0.001), greater base deficit (p<0.001), higher lactic acid (p<0.001) and erythropoietin concentrations (p=0.01), more nucleated red blood cells (p=0.004), and higher hemoglobin concentrations (p=0.002) in venous blood than in the infants born by ECS. pH was lower (p<0.001) and lactic aicid concentrations were higher (p<0.001) in arterial blood than venous blood in both groups of infants. Conclusions: (1) NVD causes reduction in oxygen transport to the fetus, resulting in acidosis and stimulation of blood forming tissues. (2) ECS is associated with more reduction in umbilical arterial cord blood oxygen content than NVD. (3) When evaluating acidosis in newborns after delivery it is more reliable to measure pH and lactic acid concentrations in arterial rather than venous cord blood.
Tilgangur: Að kanna áhrif eðlilegrar fæðingar á súrefnisflutning til fósturs. Tilfelli og aðferðir: Rannsökuð voru 50 börn sem fæddust með eðlilegri fæðingu og til viðmiðunar 50 börn sem fæddust með valkeisaraskurði. Mældir voru í naflastrengsblóði (bláæð og slagæð) þættir sem segja til um súrefnisflutning til fóstursins, það er: sýrustig blóðs (pH), hlutþrýstingur súrefnis (pO2) og koltvísýrings (pCO2), súrefnismettun blóðrauða (SO2), súrefnisinnihald blóðs, umframbasi, mjólkursýra, erythrópóíetín, kjörnuð rauð blóðkorn og blóðrauði. Niðurstöður: Ekki var marktækur munur á súrefnisinnihaldi bláæðablóðs milli hópanna. Hins vegar var súrefnisinnihald slagæðablóðs marktækt lægra hjá börnunum sem fæddust með valkeisaraskurði en hjá þeim sem fæddust eðlilega (p<0,001). Börnin sem fæddust eðlilega voru með marktækt lægra pH (p<0,001), minni umframbasa (p<0,001), hærri styrk mjólkursýru (p<0,001), hærri styrk erythrópóíetíns (p=0,01), fleiri kjörnuð rauð blóðkorn (p=0,004) og hærri þéttni blóðrauða (p=0,002) í bláæðablóði en börnin sem fæddust með valkeisaraskurði. pH var marktækt lægra (p<0,001) og styrkur mjólkursýru hærri (p<0,001) í slagæðablóði en bláæðablóði í báðum hópunum. Ályktanir: (1) Eðlileg fæðing hefur í för með sér skerðingu á súrefnisflutningi til fósturs sem veldur blóðsýringu og örvun á blóðmyndandi vefi. (2) Lækkun á súrefnisinnihaldi slagæðablóðs fósturs er meiri við valkeisaraskurð en við eðlilega fæðingu. (3) Við mat á blóðsýringu hjá barni eftir fæðingu er pH og styrkur mjólkursýru í slagæðablóði áreiðanlegri en í bláæðablóði.
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