You know you want to join us here in Adelaide in May 2009! 8-10th of May, 2009 and email Lisa for more information!
The association between cord pH at birth and intellectual function in childhood
The association between cord pH at birth and intellectual function in childhood.
Early Hum Dev. 2008 Jan;84(1):37-41.
Svirko E, Mellanby J, Impey L.
Department of Experimental Psychology, University of Oxford, Oxford, UK.
BACKGROUND: Acidemia at birth is very common but little is known about its long-term consequences.
AIM: To determine if pH at birth is related to established tests of intellectual function.
SUBJECTS: School children aged 6-8, for whom obstetric data were available, who had been delivered after labour at term, and had an umbilical cord arterial pH>7.00 (i.e. that was not extremely acidemic).
STUDY DESIGN/OUTCOMES: Retrospective cohort study correlating birth and arterial pH data with childhood tests for non-verbal intelligence, grammar comprehension and literacy. METHODS: Relationships between pH and cognitive measures were analysed with parametric correlations. Partial correlations were used to examine these relationships, controlling for possible confounding factors.
RESULTS: Arterial pH was significantly negatively correlated with literacy (p=0.001) and with non-verbal intelligence (p=0.033).
CONCLUSIONS: Lower arterial pH is associated with higher scores on literacy and non-verbal intelligence tests at ages 6-8. This is unlikely to be a chance finding and is further evidence that acidemia in isolation should not be considered an adverse outcome. Further research on the relationship between labour and long-term cognitive measures is required.
Membrane sweeping - reconsider…?
Cervical Manipulations Linked to Perinatal Sepsis: Consider GBS-specific chemoprophylaxis
OB/GYN News, Oct 15, 2001 by Kathryn DeMott
QUEBEC CITY — Obstetricians may want to hold off on performing cervical manipulation or membrane stripping to hasten labor in women with cervical/vaginal infection or colonization with pathogens, Dr. Carol Stamm reported at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology. In a series of eight case reports, Dr. Stamm of the University of Colorado, Denver, described how cervical manipulation or membrane stripping preceded perinatal sepsis and even one instance of stillbirth caused by invasive group B streptococcus (GBS) as well as other pathogens.
In each case, the salient features were the same: Each woman had a history of term gestation in a previously healthy pregnancy. All had elective or nonurgently indicated promotion of labor, digital cervical manipulation, and rapid labor with placental findings of histologically severe intrauterine infection or funisitis, half the time in the absence of classical clinical criteria of chorioamnionitis. One patient gave birth to a stillborn 15 hours after membrane stripping due to overwhelming fetal GBS sepsis. In four of the eight cases, the women had no risk factors such as known GBS infection or symptoms of chorioamnionitis; in the remaining four cases there were such red flags. It has always been assumed that such events are rare; however, their incidence can only really be established by large, prospective epidemiologic studies, Dr. Stamm noted in her poster presentation. Membrane stripping and cervical manipulation to release prostaglandins can be considerably vigorous. And this series of case reports builds on prior evidence that suggests that it is traumatic enough to cause vaginal microbes to spread into the lower uterus.
On the basis of these case reports, obstetricians may want to reconsider doing elective cervical manipulation, at least on patients who have cervical vaginal infection or colonization with potential perinatal pathogens. They may also want to consider providing GBS-specific chemoprophylaxis before membrane stripping, she said.
