Arterio-venous blood gas Δvalues for validation of umbilical cord blood samples at birth are not only biased by sample mix ups but also affected by clinical factors
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Abstract Introduction Traditional validation of umbilical cord blood samples with positive veno‐arterial ΔpH and arterio‐venous ΔpCO2 values confirms the source of samples, whereas negative Δvalues represent mix‐up of samples. To investigate whether this is true, the distributions of V‐A ΔpO2 and A‐V Δlactate were also explored and related to clinical characteristics. In addition, different cord blood sampling techniques were evaluated. Material and methods Register study with cord blood acid‐base and clinical data from 27 233 newborns. Clinical characteristics were related to positive, zero and negative Δvalues. Blood samplings from unclamped and double‐clamped cords were compared. A two‐sided P < 0.05 was considered significant. Results ΔpH and ΔpCO2 values distributed into positive, around zero, and negative sub‐populations, with significant differences in pH and clinical characteristics between sub‐populations. No such sub‐populations were distinguished for ΔpO2 and Δlactate. The 2.5th and 5th ΔpH percentiles were 0.013 and 0.022, respectively, and for ΔpCO2 0.30 and 0.53 kPa. Applying 5th percentile criteria resulted in 3.5% of “approved” cases showing a ΔpO2 ≤ 0. Puncture and sampling of the unclamped cord resulted in significantly better sample quality. Conclusions Unphysiological negative ΔpO2 values occurred despite correct validation with traditional criteria. Δlactate cannot be used for validation because both positive and negative values are physiological. Positive/around zero/negative ΔpH and ΔpCO2 sub‐populations were associated with significant differences in pH and clinical characteristics, indicating that defective sampling and sample handling are not the sole explanations for negative Δvalues. Prompt puncture and sampling of the unclamped cord resulted in best sample quality.
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Arteriovenous Dlactate cannot be used at all because 35% of values are either negative or null.
“Arteriovenous Dlactate cannot be used at all because 35% of values are either negative or null.”
From Umbilical cord pH, blood gases, and lactate at birth: normal values, interpretation, and clinical utility. (2023) · cites this paper as [63]
The Results report that 35% of Δlactate values were negative or zero. They conclude that Δlactate cannot be used to validate umbilical cord blood samples because both positive and negative values can be physiological. The claim’s “cannot be used at all” is broader than that conclusion. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn a study of 27,233 deliveries with paired cord blood samples, the only undisputed validation tool is DpO2 because the fetus cannot produce O2.
“We found that the only undisputed validation tool is DpO 2 because the fetus cannot produce O 2 .”
From Umbilical cord pH, blood gases, and lactate at birth: normal values, interpretation, and clinical utility. (2023) · cites this paper as [63]
Double validation with both DpH and DpCO2 is not needed because the difference between DpH alone and DpH combined with DpCO2 is small; DpH validation alone is enough.
“We also concluded that double validation with both DpH and DpCO 2 is not needed because the difference between DpH alone and DpH combined with DpCO 2 is small; DpH validation alone is enough.”
From Umbilical cord pH, blood gases, and lactate at birth: normal values, interpretation, and clinical utility. (2023) · cites this paper as [63]
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- Authors
- Mokarami, P., Wiberg, N., Källén, K., & Olofsson, P.
- Affiliations
- Lund University (SE)
- Corresponding author
- Olofsson, Per
- Venue
- Acta Obstetricia Et Gynecologica Scandinavica
- Publisher
- Wiley
- Published
- 2018-10-30
- Volume
- 98
- Issue
- 2
- Pages
- 167-175
- ISSN
- 0001-6349 (ISSN-L)
- 1600-0412
- OpenAlex
- W2893735355
- Cited by
- 19
- References
- 17
- Citations by year
- 2026: 10 · 2025: 1 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 2 · 2019: 1
- FWCI
- 0.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Obstetricia Et Gynecologica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Region Skåne
- Lunds Universitet
- Topics
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal Health and Biochemistry
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- umbilical cord blood, sample validation, arteriovenous oxygen difference, lactate, umbilical cord clamping, sample mix-up, neonatal acid-base status, clinical features
- MeSH terms
- Acid-Base Equilibrium, Adult, Blood Gas Analysis, Blood Specimen Collection, Carbon Dioxide, Female, Fetal Hypoxia, Fetal Blood, Humans, Hydrogen-Ion Concentration, Infant, Newborn, Oxygen, Pregnancy, Sweden, Reproducibility of Results, Delivery, Obstetric
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