Umbilical Cord Blood Gas

• Birth Injury
• Umbilical Cord Blood Gas

What Is Umbilical Cord Gas?

After birth, babies receive oxygen like everyone else: using their lungs to breathe oxygen in and breathe carbon dioxide out. But during pregnancy, amniotic fluid surrounds the baby and prevents them from using their lungs to breathe.

Instead, the baby receives all oxygen from blood that flows through the umbilical cord vein. The umbilical cord arteries remove carbon dioxide from the baby’s system and return it back to the placenta.

Analyzing cord blood samples after birth can determine if the baby suffered from birth injuries like hypoxia or birth asphyxia. Babies who suffer from oxygen deprivation are at a higher risk for brain injuries like hypoxic ischemic encephalopathy (HIE). HIE is a permanent form of brain damage at birth that can cause developmental delays and lead to cerebral palsy.

In simple terms, blood gas can help establish whether the baby experienced significant oxygen deprivation around the time of birth.

Medical providers should draw arterial blood gas samples immediately after the baby’s birth. The results can help them objectively determine the baby’s metabolic condition (whether they are “acidotic” due to lack of oxygen).

Research suggests that umbilical cord blood analysis can determine if a baby suffered from brain damage at birth. Other measurements, such as non-reassuring fetal heart rate readings, low APGAR scores, and MRI neuroimaging, can support a doctor’s suspicions.

This information is critical to determine the baby’s need for immediate intervention treatment like therapeutic hypothermia brain cooling. Failing to provide this treatment or making errors during labor can cause a child’s brain injury or worsen its effects. When a child’s long-lasting birth injuries are the result of medical negligence, families may have a viable medical malpractice claim.

Birth Injury Malpractice Attorneys

Our top rated birth injury attorneys specialize in identifying when medical errors cause or worsen a baby’s brain damage at birth. If you or someone you know suffered from the effects of birth injury negligence, don’t hesitate to contact our firm. We can answer difficult legal and medical questions and investigate the facts on your behalf.

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Our Birth Injury Lawyers are available to meet you in your home or the hospital.

Our vast network of medical experts and in-house nursing staff and nurse-attorneys gives us the edge over our competition. When we take your case, we assign you with an entire medical team. This team not only consists of attorneys but also nursing advocates and medical experts.

Your team is available to assist with any day-to-day treatment you or your child may need. This includes assistance with medical records, scheduling doctors’ appointments, providing transportation, and any other problems that may arise.

We offer all of this on a contingency fee basis. This means you will not pay any fees until after we win your case and secure a settlement. Miller Weisbrod Olesky’s unmatched track record of birth injury results sets us apart from other birth injury law firms.

Recent Birth Injury Settlement:
Birth Injury settlement against a hospital in which nurses and physicians failed to properly monitor the mother's blood pressure during delivery causing an HIE event resulting in neonatal seizures and cerebral palsy at birth. Our team of top-rated birth injury lawyers recovered $13,750,000 for the family to help with future medical expenses and developmental therapy.

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What does Blood Gas Testing Actually Test?

Umbilical cord blood contains several characteristics that give doctors valuable insight into the baby’s oxygen levels and overall wellbeing. If test results suggest an oxygen deficiency (hypoxia), doctors should suspect a neonatal brain injury and conduct further antenatal testing.

The most important metrics for doctors to test in umbilical cord blood include the following:

pH Testing

pH is an indicator of the acidity level in the baby’s blood. A pH value lower than 7 means the baby’s blood is more acidic. Acidic blood is not good: it indicates the baby has high concentrations of carbon dioxide in the blood (pCO2).

A low arterial cord blood pH value has a strong correlation with fetal hypoxia and fetal acidemia during birth. In prolonged cases, hypoxia and acidosis can cause irreversible injury to the brain like hypoxic ischemic encephalopathy (HIE).

Base Excess/Base Deficit

A base excess or deficit tells doctors how much bicarbonate is in the baby’s blood. Bicarbonate is an electrolyte in the body that regulates pH balance.

Base excess/deficit tells doctors how much bicarbonate must be added or removed from the blood to maintain a healthy pH.

Base Excess is a positive number. It is how much excess bicarbonate is in the baby’s blood that requires removing for pH balance.

Base Deficit is a negative number. It is how much bicarbonate is missing from the baby’s blood to reach a healthy pH balance.

Higher base deficits are an indicator of more severe fetal acidosis. Severe fetal acidosis causes acute oxygen deprivation, increasing the risk of hypoxic ischemic encephalopathy (HIE) and consequently cerebral palsy.

PaO2 and PaCO2

Healthcare providers test gas levels by measuring the pressure they exert as they dissolve into the blood plasma. This is how they can estimate the baby’s oxygen and carbon dioxide levels in their blood.

PaO2, or partial pressure of oxygen, is a measure of oxygen levels within arterial cord blood. Low levels of PaO2 suggest the baby suffered from fetal hypoxia or birth asphyxia during pregnancy or during delivery.

PaCO2, or partial pressure of carbon dioxide, is a measure of the carbon dioxide levels within arterial cord blood. High PCO2 levels mean there’s increased hydrogen ion concentration and an accumulation of lactic acid within the blood. These are key signs the baby experienced fetal acidosis.

Low PaCO2 levels indicate the baby may have hypocarbia, which can also increase the risk for brain injuries like HIE.

Collecting an Umbilical Cord Blood Gas Sample

To draw the umbilical cord blood for gas and acid-base status after birth, the following three steps are generally performed:

• Clamp a segment of the umbilical cord
• Remove the cord segment which is clamped
• Use needle aspiration to draw two blood specimens (one arterial and one venous) from the removed clamped segment into syringes

The timing of obtaining the sample for analysis is critically important. Right after birth, ideally before the first breath of the baby, a cord segment (about 20 cm) should be isolated using two clamps. A clamping delay of as little as 45 seconds can materially change the acid-base status, rendering the results unreliable. The greater the delay, the more unreliable will be the measurements.

What are Abnormal Arterial Cord Blood Gas Results?

Normal pH results on blood gas testing are between the range of 7.18-7.38. Anything lower shows the baby likely suffered fetal distress that caused the blood to become more acidic.

• PaCO2: A normal result is typically around 35.3-45.0 mmHg. Results higher than 45 mmHg may indicate respiratory acidosis and results lower than 32 mmHg may indicate hypocarbia.
• Pa02: A normal result for arterial blood gas testing is between 75-100 mmHg. Oxygen pressure levels above 120 mmHg are a sign of hyperoxemia, whereas levels under 60 mmHg can indicate hypoxemia.
• Base Excess: A Normal result is anywhere -8 to 0. Anything lower than -8 shows that the baby was acidic prior to birth

Respiratory Acidosis Vs. Metabolic Acidosis

Medical providers should also note the difference in cord blood results between respiratory acidosis versus metabolic acidosis.

Respiratory acidosis stems from a buildup of carbon dioxide in the tissues. When this happens, the umbilical cord blood results will return lower pH values but a normal level of base excess. Respiratory acidosis indicates the baby’s oxygen deprivation stems from an impairment to fetal gas exchange.

Metabolic acidosis stems from a buildup of lactic acid due to a lack of oxygen. In these cases, the umbilical cord blood tests will return a similarly low pH but also a high base deficit. This indicates the baby’s body cannot produce enough bicarbonate to neutralize the acid buildup in their tissues.

Birth Asphyxia and Fetal Acidosis

Cord blood gas test results are valuable in birth injury cases because they provide measurable objective evidence of birth asphyxia.

Birth asphyxia occurs when the baby loses access to oxygen for a prolonged period. When the baby’s tissue cells have insufficient oxygen, the accumulation of metabolic acids (primarily lactic acid) lowers pH levels. This is what ultimately leads to fetal acidosis.

Research suggests that blood gas tests are usually more reliable than the APGAR score and other routine clinical assessments. This is because APGAR scores depend upon the subjective opinions of doctors and nurses. These medical professionals may not assess the baby correctly or may “overcall” the score to hide or excuse their medical malpractice.

Cord Blood Metabolic Acidosis and HIE

Researchers commonly define severe fetal acidosis as cord arterial blood pH below 7.0 and base excess below -12.0 mmol/L. This degree of metabolic acidosis comes with a heightened risk of hypoxic-ischemic encephalopathy (HIE), which can lead to cerebral palsy. HIE reflects neurological dysfunction in babies with symptoms like poor feeding, hypotonia, seizures, respiratory problems, and developmental delays.

Babies with moderate or severe HIE often have permanent and severe neurological disabilities, including a cerebral palsy diagnosis. Currently, therapeutic hypothermia (controlled brain cooling therapy) is the only effective treatment for HIE. Its effectiveness will depend on the medical team’s ability to initiate it within six hours of birth.

A pH below 7.0 and base excess lower than -12.0 mmol/L are two of key indicators for initiating hypothermic treatment. Research shows that hypothermia can either prevent the occurrence of cerebral palsy or at the very least reduce its severity.

Why Would a Follow-up Blood Gas Result Get Worse?

Many babies need neonatal resuscitation at birth because of respiratory distress, meconium aspiration or as a result of fetal distress. If doctors delay neonatal resuscitation or fail to have a neonatology team present, a baby’s hypoxia and acidosis may worsen.

Worsening blood gas results can be a powerful indicator that medical malpractice occurred after birth due to delayed antenatal treatment. It can sometimes be a sign that medical professionals failed to address common birth complications like jaundice or neonatal hypoglycemia.

Collecting an Umbilical Cord Blood Gas Sample

To draw the umbilical cord blood for gas and acid-base status after birth, the following three steps are generally performed:

• 1. Clamp a segment of the umbilical cord
• 2. Remove the cord segment which is clamped
• 3. Use needle aspiration to draw two blood specimens (one arterial and one venous) from the removed clamped segment into syringes

The timing of obtaining the sample for analysis is critically important. Right after birth, ideally before the first breath of the baby, a cord segment (about 20 cm) should be isolated using two clamps. A clamping delay of as little as 45 seconds can materially change the acid-base status, rendering the results unreliable. The greater the delay, the more unreliable will be the measurements.

According to the Clinical and Laboratory Standards Institute (CLSI) recommendations, the arterial cord blood samples should be analyzed in less than 30 minutes after collection. Since the veins and arteries in the umbilical cord are closely located, the medical team can sometimes mistakenly sample venous blood while assuming it to be arterial blood.

For this reason, experts recommend that blood specimens should be obtained from both the cord vein and artery for analysis to ensure that arterial blood test results can be conclusively validated as arterial.

Well-founded studies have found that errors in collecting the cord blood gas sample can cause invalid results in 20% of blood gas results. Therefore, in a birth injury lawsuit the blood gas results must be carefully evaluated by an experienced birth injury attorney. We have seen many cases with “normal” blood gas results, but clear evidence that fetal distress and hypoxia occurred during the labor and delivery period.

Factors Interfering with Cord Blood Gas Values

Certain medical mistakes can compromise the reliability of umbilical cord arterial blood samples. The following errors are the most common reasons for missing the signs of fetal acidosis at birth:

Delays in Sampling

Delays in drawing blood gas samples will result in unreliable results and distorted values of pH, PaO2 and PaCO2.
Similarly, a delay in the interpretation of test results can also make the readings unreliable. The Clinical and Laboratory Standards Institute (CLSI) recommends analyzing the arterial cord blood samples within 30 minutes of collection. Any readings after this window can be inaccurate and may paint a false picture of the baby’s status.

Delays in Cord Clamping

If medical professionals delay the clamping of the baby’s umbilical cord, it can alter the entire blood gas analysis. Healthcare providers should obtain samples from the unclamped cord soon after birth to determine the most accurate measurements. But a delay in cord clamping after delivery will also lower the reliability of test results.

Mistaken Samples

Because of their proximity, the medical team sometimes mistake venous blood samples for arterial blood. This can create issues because venous blood will return significantly different numbers than arterial blood. For this reason, experts recommend obtaining blood specimens from both blood vessels.

Well-founded studies show that errors in collecting the cord blood gas sample cause invalid results in nearly 20% of tests. Therefore, a specialized birth injury attorney should always evaluate the sample for themselves while searching for evidence of medical malpractice.

Additional Factors

Factors such as fetal presentation and the mode of delivery may also impact the cord blood gas values. In a vaginal delivery, metabolic stress is higher because of uterine contractions, resulting in slightly lower cord pH values.

In a planned cesarean section without labor, the cord pH values will be relatively higher. Similarly, babies born with breech (feet-first) presentation will have lower umbilical cord pH value compared to babies presenting head-first.

The differences between arterial and venous cord gas values may also be indicative of the nature or timing of birth asphyxia. But cord complications like compression, prolapse, or nuchal cord may lead to significant arteriovenous (AV) differences. Similarly, small clots in the cord blood may also interfere with blood gas sample analysis.

American Obstetricians Guidelines For Blood Gas Testing

The American College of Obstetricians and Gynecologists recommends medical professionals only perform umbilical cord blood gas testing in selective cases. ACOG recommends testing in the following cases:

• Emergency C-section due to labor & Delivery complications
• Low APGAR score
• Non-reassuring fetal heart rate readings
• Severe IUGR (intrauterine growth restriction)
• Intrapartum fever from suspected neonatal infections
• Maternal thyroid disease
• Twin labor or pregnancy with multiples

In contrast to ACOG guidelines, some research suggests benefits in performing cord blood analysis as standard procedure for all births. For example, the Society of Obstetricians and Gynecologists of Canada (SOGC) recommends umbilical cord blood testing for every baby.

If doctors and nurses miss physical signs of fetal distress or birth complications, blood gas testing provides proof. Failing to test the blood can keep these injuries hidden and delay critical intervention treatment like cooling therapy.

Is Your Child’s Birth Injury the Result of Medical Malpractice?

Children who suffer from hypoxia during birth or during pregnancy can suffer from serious birth injuries like fetal acidemia. These complications can cause irreversible brain injuries like hypoxic ischemic encephalopathy, which can permanently alter a child’s life trajectory.

Parents may wonder if medical professionals did everything they could during labor and delivery to prevent these outcomes. They may question:

• Were there signs of a birth injury during the pregnancy or labor, and delivery process?
• Did the medical team fail to order important blood gas tests to diagnose suspected fetal hypoxia in a timely manner?
• Did the medical team mix up the results of venous and arterial blood gas tests?
• Did the medical team misinterpret the results of the blood gas testing?
• During the labor and delivery, were there clear indications that their baby was suffering from fetal distress?
• Did the neonatal resuscitation team delay in providing important breathing support after birth?
• Did doctors miss serious neonatal conditions like hypoglycemia or jaundice after birth?
• Should medical professionals have offered brain cooling (also called “hypothermia therapy”) to your baby?

Our top rated birth injury lawyers want to help you find those answers. If you believe improper testing procedures caused or worsened your child’s injuries at birth, legal support may be an option. A specialized birth injury attorney can review the medical records and circumstances to assess whether a claim exists.

Families who have experienced the effects of brain injuries from negligent medical care deserve to know whether they were avoidable. Our team at Miller Weisbrod Olesky will thoroughly investigate the facts, holding responsible parties accountable by pursuing medical malpractice claims.

What is the Statute of Limitations in a Birth Injury Lawsuit?

A statute of limitations (SOL) is a law that sets a time limit on how long an injured person has to file a lawsuit after an accident. It is essential to understand that statutes of limitations vary based on the case and the state where you file. For instance, the deadline for birth injury claims is typically different from other claims, such as injury to private property.

Generally, the clock starts ticking on the date the injury occurred. However, there are exceptions to this rule. In some cases, the statute of limitations starts when a person discovers or reasonably should have discovered an injury. When dealing with government agencies, SOLs can become even more complex.

For example, if the party that injured you was:

• A federal employee
• Employed by a military hospital, Veterans Administration facility, or a federally funded medical entity

You may need to file a birth injury claim under the Federal Tort Claims Act (FTCA). In FTCA cases, claimants must go through certain administrative procedures before filing a lawsuit. In some states, you may have less time to give notice if:

• The negligent party was a local or state government hospital
• The doctors and medical providers are employees of a governmental entity

If you file your case outside of the statute of limitations, the court will typically dismiss it. This means you will not be eligible to recover compensation for you or your child’s injuries.

Determining when a statute of limitations begins on your case can be tricky. If you are considering pursuing compensation for a birth injury, contact an attorney as soon as possible.

How Can Our National Birth Injury Attorneys Help?

Doctors can sometimes prevent fetal acidemia and brain injuries by responding to concerning umbilical cord blood gas results. However, it takes an expert review of the facts of your birth to determine whether medical professionals made preventable errors.

Our Process

At Miller Weisbrod Olesky, our team of committed attorneys, nurses and paraprofessionals works to answer these questions and seek compensation. We use our detailed medical negligence case review process to assess your potential birth injury case.

We start by learning more about your pregnancy by gathering records to determine what happened during and after your delivery. This includes evaluating the fetal heart rate strips during labor and umbilical cord arterial blood gas testing procedures after birth.

We will call in skilled medical experts who review your records and provide insight into where medical professionals went wrong. If we feel improper testing procedures caused or worsened your baby’s injuries, we meet with you to discuss further.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment once you do. The sooner you reach out, the sooner we can investigate your case and gather the evidence to support your claim.

We work on a contingency fee basis, meaning you will not pay any legal fees until we win your case. We do not purse any medical malpractice cases unless we fully believe we can win.

Contact us today to schedule your free consultation by calling our toll-free line at 888-987-0005. You can also reach us by filling out our online request form.