OB-GYN-L Messages for May, 2000: Re: routine intrapartum labs

Re: routine intrapartum labs

From: Geffrey Klein, MD

gklein@icsi.net

Sat May 27 09:43:48 2000

>What is this group's opinion of routine cord gases for all infants
>regardless of Apgars? I am in a new hospital where this is standard
>practice and have been chastised by several MDs for not getting them,
>even when the babies are pink and screaming with excellent apgars. In
>my previous hospitals, we only got them if the apgars were poor or after
>a difficult delivery.
>Also, is there any reason to get a CBC and diff on every intrapartum
>patient? When I asked about this, no one could remember when they had
>actually changed their management based on the CBC, and most of them are
>just filed in the chart and not looked at.

Per ACOG CO 138:

Immediately after delivery of the neonate, a segment of umbilical cord should be doubly clamped,divided, and placed on the delivery table pending assignment of the 5-minute Apgar score. Values from the umbilical artery provide the most accurate information regarding fetal and newborn acid-base status. A clamped segment of cord is stable for pH and blood gas assessment for at least 60 minutes, and a cord blood sample in a syringe flushed with heparin is stable for up to 60 minutes. If the 5-minute Apgar score is satisfactory and the infant appears stable and vigorous, the segment of umbilical cord can be discarded. If a serious abnormality that arose in the delivery process or a problem with the neonate's condition or both persist at or beyond the first 5 minutes, blood can be drawn from the cord segment and sent to a laboratory for blood gas analysis. It should be noted that, occasionally, it may be difficult to obtain an adequate cord arterial blood sample.

_________________________

My Conclusions:

-- _________________________

1) cord gas is defensive medicine and NEVER alters the management of mom or baby 2) cord gas can be used to help exonerate a doc by excluding intrapartum asphyxia as the cause of a poor outcome 3) in a vigorous infant, a cord gas can only hurt the doc by suggesting metabolic acidemia when the baby is fine 4) cord gasses cost money to perform

So.. *** WARNING.. MY OPINION FOLLOWS ****

If a doc insists on performing cord gasses at EVERY delivery, he is spending the patient's money on a test that will not be used to help manage her case. However, if for medicolegal purposes, the doc really feels that this is a helpful thing to do,even though it is not, then he should pay for the test himself...

______

As for the issue of CBC. We get that on admission because of the high incidence of anemia in pregnant patients. It is a good baseline measurement and has on occasion made me aware of severe anemia that I was not expecting. A platelet count is usually requested by anesthesia prior to administering an epidural. On occasion, the first clue that a patient has HELLP syndrome is gleaned by the admission CBC..

-- _______________________ Geffrey H. Klein, MD _______________________ geffrey.klein@obgyn.net 200 Medical Center Blvd Suite 103 Webster, TX 77598 (281) 332 6723

http://www.geffreyklein.com

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