De Zorzi Patrícia de Moraes, Madi José Mauro, Rombaldi Renato Luís, de Araújo Breno Fauth, Zatti Helen, Madi Sônia Regina Cabral, Barazzetti Daniel Ongaratto
Programa de Residência Médica de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre da Universidade Federal do Rio Grande do Sul-UFRGS-Porto Alegre, RS, Brasil.
Rev Bras Ginecol Obstet. 2012 Aug;34(8):381-5. doi: 10.1590/s0100-72032012000800007.
To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7.0.
Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05.
Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001).
Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.
评估与脐动脉pH<7.1且出生后5分钟阿氏评分<7.0的足月儿相关的围产期因素。
回顾1998年9月至2008年3月在南卡希亚斯综合医院发生的所有分娩的病历后进行回顾性病例对照研究。纳入标准为出生后5分钟阿氏评分<7.0且脐动脉pH<7.10的足月儿。在单因素分析中，我们对连续变量使用了学生t检验和曼-惠特尼检验，对二分变量使用了c²检验，并通过比值比（OR）进行风险估计。显著性水平设定为p<0.05。
在总共15495例连续分娩中，25例足月儿（0.16%）脐动脉pH<7.1且出生后5分钟阿氏评分<7.0。臀位分娩（OR=12.9，p<0.005）、剖宫产（OR=3.5，p<0.01）和改良产时胎心监护（OR=7.8，p<0.02）与酸中毒事件存在显著关联。在胎儿特征方面，入住新生儿重症监护病房的需求（OR=79.7，p<0.0001）、复苏需求（OR=12.2，p<0.0001）和碱缺失与该事件相关（15.0对-4.5，p<0.0001）。
出生后5分钟阿氏评分低且脐动脉pH<7.1可预测不良新生儿结局。
