Hidden acidosis: an explanation of acid-base and lactate changes occurring in umbilical cord blood after delayed sampling.

OBJECTIVE

To explore the 'hidden acidosis' phenomenon, in which there is a washout of acid metabolites from peripheral tissues in both vaginal and abdominal deliveries, by investigating temporal umbilical cord blood acid-base and lactate changes after delayed blood sampling.

DESIGN

Prospective comparative study.

SETTING

University hospital.

SAMPLE

Umbilical cord blood from 124 newborns.

METHODS

Arterial and venous cord blood was sampled immediately after birth (T₀), and at 45 seconds (T₄₅), from unclamped cords with intact pulsations taken from 66 neonates born vaginally and 58 neonates born via planned caesarean section at 36-42 weeks of gestation. Non-parametric tests were used for statistical comparisons, with P < 0.05 considered significant.

MAIN OUTCOME MEASURES

Temporal changes (T₀-T₄₅) in umbilical cord blood pH, the partial pressure of CO₂ (PCO₂) and O₂ (PO₂), and in the concentrations of lactate, haematocrit (Hct), and haemoglobin (Hb).

RESULTS

In both groups all arterial parameters, except for PCO₂ in the group delivered by caesarean section, changed significantly (pH decreased and the other variables increased). There were corresponding changes in venous acid-base parameters. When temporal arterial changes were compared between the two groups, the decrease in pH and increase in PCO₂ were more pronounced in the group delivered vaginally. Neonates born vaginally had significantly lower pH and higher lactate, Hct, and Hb concentrations at T₀ and T₄₅ in both the artery and the vein. At T₄₅, arterial PCO₂ and PO₂ levels in the group delivered vaginally were also significantly higher.

CONCLUSIONS

Delayed umbilical cord sampling affected the acid-base balance and haematological parameters after both vaginal and caesarean deliveries, although the effect was more marked in the group delivered vaginally. The hidden acidosis phenomenon explains this change towards acidaemia and lactaemia. Arterial haemoconcentration was not the explanation of the acid-base drift.