Immediately after birth, ideally before the babys first breath, an approximate 20-cm segment of cord must be isolated between two sets of two clamps. Early Human Development 2010; 86: 329-38, Perlman J. Intrapartum hypoxic-ischemic cerebral injury and subsequent cerebral palsy. This potential safety audit function of universal cord blood gas testing is addressed by a recent study [1] that suggests adoption of a universal testing policy resulted in improved perinatal outcomes. Martin GC, Green RS, Holtzman IR. Blood cord gases results can be used as an important piece of evidence in birth injury litigation. Even on routine, vigorous deliveries, getting into this habit as part of your deliveries will help you be prepared. Causticizing Efficiency Calculator. 60 minutes. Arterial Blood Gas (ABG) Calculator pH : PaCO2 : mm Hg HCO3 : mEq/L Result : Please fill out required field. New York, Holt Rinehart Winston; 1972, p274-5. Your body normally tightly regulates the amount of oxygen and carbon dioxide in your . Once terminal fetal bradycardia has begun, the umbilical venous blood flow does not reopen; therefore, the venous sample is usually a reasonable proxy for the infant's acid-base status prior to terminal fetal bradycardia. Description. The respiratory acidosis in the arterial sample is also mild, but there is also a mild metabolic acidosis. NCCLS document H11-A4. Fetal acid-base balance can be assessed in a number of ways: Antepartum, by percutaneous umbilical cord blood sampling. The growing fetus depends for oxygen and nutrients on maternal blood supply. Benirschke K, Kaufman P. Architecture of normal villous trees, In: Pathology of the Human Placenta, 2nd edition. Eur J Obstet Gynecol Repro Biol. Abnormal cord blood gas results are a marker for a birth injury. As one erudite neonatologist summarized, "Just add water! Teitel DF, Iwamoto HS, Rudolph AM. Birth injury lawyers also need to work closely with a medical expert to prove the cause and timing of the birth injury. Scenario 1. A. Am J Obstet Gynecol 1985;151:798-800. They should be taken when there has been concern about the baby either in labor or immediately following birth.. Instead, the exchange of gases, breathing occurs in the placenta where oxygen is transported from the mother's blood vessels into the placenta and then from the placenta through the umbilical cord to the fetus and carbon dioxide is exchanged from the fetus to the mother. Altogether, they help to determine the status of the patient - their acid-base balance. However, it seems safe to assume that a difference of 4 mmol/L or more is significant. Use of umbilical cord blood gas analysis in the assessment of the newborn. The blood-gas values were statistically analyzed and reported. American Academy of Pediatrics: Textbook of Neonatal Resuscitation, 7th ed. HIE is thus a significant cause of perinatal death and birth-related permanent disability. Westgate JA, Bennett L, Gunn AJ. Asphyxia is reduced tissue oxygen (hypoxia) of sufficient severity and duration to cause metabolic acidosis [5]. Use of volume expansion during delivery room resuscitation in near-term and term infants. J Pediatr 1971;79:406-12. Arterial Blood Gas (ABG) Analyzer - MDCalc Arterial Blood Gas (ABG) Analyzer Interprets ABG. This is why the cord must be clamped quickly. There is no general agreement on the definition of a widened base deficit difference. See also Legal info. The pH of venous blood should be between 7.31 and 7.41, whereas arterial blood should be between 7.35 and 7.45. Vanhaesebrouck P, Vanneste K, de Praeter C, van Trappen Y. In addition to his current work, Dr. Amos is using his vast experience to launch Obie, a science-based app that offers personalized fertility advice. Test your knowledge on the web's most interactive blood gas learning tool. Blood gas analysis is a commonly used diagnostic tool to evaluate the partial pressures of gas in blood and acid-base content. To my knowledge, all animal studies of fetal cord occlusion involve sudden and complete occlusion rather than any period of continued venous occlusion with the restored arterial flow. Usher R, Shephard M, Lind J. Base buffers have been used to maintain oxygenation B. Fetal heart rate variability changes during brief repeated umbilical cord occlusion in near term fetal sheep. a) Contamination of the arterial sample with an air bubble resulting . Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. Info. There is currently a plague of 'venous' blood gases (VBG) in clinical practice. Well summarized and easy to under stand and remember . NEONATOLOGYTODAY Volume 15Issue 11 Pages 54-57 Release date: November 2020 DOI: https://doi.org/10.51362/neonatology.today/20201115115457 [Click Here to Download PDF], [Full Text][Figures & Tables][Article Info][Reference]. Haruta M, Funato T, Sumida T, Shinkai T. The influence of oxygen inhalation for 30 to 60 minutes on fetal oxygenation. Cord blood P o2 and P co2 The blood gas analyser measures pH, P co2 and P o2 and then calculates base excess after normalising P co2. Significant metabolic acidosis (i.e. The pros and cons of selective versus routine cord blood gas analyses were discussed by Thorp et al [20]; their views are summarized below. Maternal-fetal acid-base physiology. However, when umbilical cord occlusion associated with terminal bradycardia is the underlying pathology, the umbilical artery sample typically has a worse base deficit than in the umbilical vein sample. An infant was delivered via cesarean. At birth, a 10- to 20-cm segment of umbilical cord is doubly clamped and cut. The last case I referred to them settled for $1.2 million. Expel all air bubbles. It follows, theoretically at least, that arterial cord-blood lactate concentration should be as reliable an indicator of birth asphyxia and risk of HIE as the more established tests, arterial cord-blood pH and base excess. Cord Blood Gas Results | What You Need to Know. Under these circumstances it cannot be assumed that the results relate to arterial blood; indeed, it is most probable, given the relative ease of sampling venous blood, that they relate to venous blood. Molar Mass Of Gas Calculator. Calculate. Results: The cord blood collected from 160 newborns was analyzed in this study. You are asked to review a 63-year-old female who was admitted with shortness of breath. We calculated Spearman correlation coefficients and receiver operating characteristic curves for various levels of umbilical artery pH, base excess, and Apgar scores. 3. The article begins with some background physiology/anatomy of placental/fetal circulation that highlights the all-important distinction between arterial and venous cord blood for accurate assessment of fetal/neonatal acid-base status. What about a PO2 level? Wider differences suggest a longer interval of umbilical vein obstruction with the restored umbilical arterial flow and greater fetal hypovolemia. Australia and New Zealand J of Obstetrics and Gynaecology 2010; 50: 318-28, Get fertility advice personalized for you, Umbilical cord base excess or base deficit, needle aspiration of two blood samples (one venous, one arterial) from the excised clamped cord segment into pre-heparinized syringes. The case settled and I got a lot more money than I expected. Normal Arterial Blood Gas Values pH : 7.36-7.44 PaCO2 : 36-44 mm Hg HCO3 : 22-26 mEq/L Legal Notices and Disclaimer All Information contained in and produced by the Pediatric Oncall system is provided for educational purposes only. Following tissue extraction of oxygen and nutrients, fetal blood returns to the placenta via two small umbilical arteries. A widened difference in PCO2 (18 mmHg or greater) in the absence of a widened pH difference is clinically quite rare. Both are used to determine the acidity level in the umbilical cord. Reduced prevalence of metabolic acidosis at birth: an analysis of established STAN usage in the total population of deliveries in a Swedish district hospital. Differences between umbilical venous and arterial samples can become very wide (see next installment). However, doctors can also use blood cord gases to defend birth injury lawsuits as well. Calcium Equivalents. Respiratory acidosis refers to high acid levels caused by impaired lung function, leading to retained carbon dioxide in the lungs and bloodstream. The applicability of cord blood gas analysis is an unresolved controversy that will be addressed: should cord blood gas analysis be reserved for defined high-risk deliveries or should it, as some advise, be more universally applied at all hospital births? 16,17 Current cord blood gas reference ranges were defined when early cord clamping at less than 30 seconds was routinely practiced. Case of the Missing Cord Gases: No Standing Orders or Reminder to Provider to Order Umbilical Cord Gases provide evidence of infant's condition at birth relative to acidosis & labor Need both umbilical arterial gases And umbilical venous gases Can cut & clamp cord & set aside until newborn's status is determined The interpretation of blood cord gas levels can also be used by malpractice lawyers and medical experts to show the severity of damage that occurred during delivery by citing the specific pH and base deficit levels. It was a good review of ABG analysis. Of course, terminal cord occlusion does not preclude severe repetitive cord occlusion with insufficient time for even the PCO2 to fully recover between occlusive episodes or a preexisting or simultaneous occurrence of uteroplacental insufficiency. They quite literally worked as hard as if not harder than the doctors to save our lives. For many years it has been standard obstetric practice to clamp the umbilical cord within seconds of birth, a policy that is, as discussed above, coincidentally fortuitous for the most accurate assessment of neonatal acid-base status. The time-volume relationship has not yet been quantified, but the duration of umbilical arterial blood flow in the absence of venous return is likely to vary from just a minute or two to probably not more than 10-15 minutes in the extreme. Remove ALL air and gently rotate for 30 seconds . Assuming a normal distribution of differences between umbilical venous and arterial pH, the upper limit of the 95th percentile range is 0.10 (see Case 5). Arterial Blood Gases (ABG) Calculator The arterial blood gases calculator calculates whether an individual is in metabolic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis, or is normal. The wider the differences between umbilical venous and arterial samples, likely the longer the interval of umbilical vein obstruction with the restored umbilical arterial flow. In addition to his current work, Dr. Amos is using his vast experience to launch Obie, a science-based app that offers personalized fertility advice. Tight nuchal cord and neonatal hypovolemic shock. Introduction, indications and sources of errors 2. BLOOD GAS ANALYSIS. This so-called hidden acidosis phenomenon is thought to be a transient physiological effect of initiation of neonatal breathing [13] and can give a false impression of significant acidosis at birth. It is important to distinguish cord-blood metabolic acidosis and cord-blood respiratory acidosis; the latter is characterized by reduced pH but normal base excess. The design of this study depended on the policy of universal cord blood gas testing that had been adopted in the obstetric unit where the study was conducted. The most likely pathophysiology is as follows: Initially, in terminal cord occlusion, both the umbilical vein and the umbilical arteries are occluded. Below, the venous and arterial cord gases each have been "normalized" to a \(P_{CO_{2}}\) of 38 and 49 mmHg (the mean normal venous and arterial \(P_{CO_{2}}\)), respectively, as is done artificially by the equation used to calculate the base deficit in blood gas analyzers. It should look like this: Now lets solve a problem using the tic tac toe method: ABG results are the following..pH 7.24, PCO2 75, HCO3 28. SIG is the Strong Ion Gap. Draw your tic tac toe . Pediatrics 2005;115:950-5. APGAR Scores; Braden Scale . a negative base excess) is defined by the amount of strong base that must be added. The fetus does not breathe in the same way humans do outside the womb (although chest movement or practice breathing do happen inside the uterus before birth). Obstet & Gynecol 2010; 1(9): WMC00694, Mokorami P, Miberg N, Olofsson P. An overlooked aspect on metabolic acidosis at birth: blood gas analyzers calculate base deficit differently. Likewise, any umbilical venoarterial PCO2 difference of greater than 18 mmHg also is associated with either cord occlusion with terminal fetal bradycardia or chronic fetal heart failure with terminal fetal bradycardia. The entire team from the intake Samantha to the lawyer himself (Ron Miller) has been really approachable. Pediatr Res 2007;61:415-20. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. According to one study, up to 19% of blood cord gas samples are invalid due to human error. Base Excess. Obstet Gynecol 1992; 79: 959-62. (3,4) Finding a pH difference greater than 0.10 suggests either cord occlusion with terminal bradycardia or chronic fetal heart failure with terminal bradycardia. Price DC, Ries C. Hematology. Venous cord blood analysis reflects a combination of maternal acid-base status and placental function . There may have been an error in the process of storing and analyzing the blood. What's the diffe. Because there is more acidic carbon dioxide (CO2) in the venous circulation, this occurs. Edelstone DI, Peticca BB, Goldblum LJ. Blood gases can be performed from cord, arterial, venous or capillary specimens. With intact umbilical-placental circulation, any metabolic acidosis appearing in the umbilical artery will almost instantaneously appear in the umbilical vein. We serve the following localities: Baltimore; Prince George's County including Bowie, Laurel, Landover, Hyattsville; Anne Arundel County including Glen Burnie; Baltimore County including Cockeysville, Glyndon, Hunt Valley, Jacksonville, Lutherville-Timonium, Owings Mills, Parkville, Reisterstown. This now deoxygenated blood contains the waste products of fetal metabolism, including carbon dioxide (pCO2), for elimination from maternal circulation via lungs and kidneys. The standard technique of sampling cord blood for gas and acid-base analysis comprises three steps: clamping a segment of the cord removing the clamped cord segment needle aspiration of two blood samples (one venous, one arterial) from the excised clamped cord segment into preheparinized syringes accurately in order to calculate exact base excess. However, it is important to note that the ABG calculator should not be used as a substitute for clinical judgment. Once the umbilical vein becomes occluded, a blood gas sample will only reflect the status prior to the occlusion. Symptoms among affected neonates include hypotonia, poor feeding, respiratory difficulties, seizures and reduced level of consciousness. Due to thicker, muscular and innervated walls, arteries are also more painful to puncture than veins. Am J Obstet Gynecol 2010; 202: 546 e1-7, Nordstom L. Lactate measurement in scalp and cord arterial blood. Your doctor may run a blood gas analysis or arterial blood gas (ABG) test if you are showing the signs of an oxygen, carbon dioxide, or pH imbalance such as confusion or difficulty breathing. Immediately after birth, ideally before the babys first breath, an approximate 20-cm segment of the cord must be isolated between two sets of two clamps. Delay in clamping by as little as 45 seconds after birth results in significant change in acid-base parameters [13-15]; the longer the delay, the greater is the change [16, 17]. The book makes the distinction between acute and chronic disorders based on symptoms from identical ABGs. 2008; 139: 16-20, Koshnow Q, Mongelli M. Cord blood lactate and pH values at term and perinatal outcome: a retrospective cohort study. Normal pH value ranges for venous blood are 7.31-7.41, while normal pH of arterial blood is 7.35-7.45.It means that venous blood is more acidic than arterial. Clearly, PO2 is not always elevated following cord occlusion with terminal bradycardia. If the episodes are severe enough or frequent enough, there may be insufficient time for complete recovery between episodes, and acid-base values will deteriorate over time. (14,15) This results in progressive deterioration of the blood gas in the umbilical arteries as long as blood continues to flow in these vessels. As far as I am aware, cord occlusion with terminal bradycardia has never been studied separately as a cause of neonatal asphyxia. (16). A capillary blood gas (CBG) is a test that involves puncturing and collecting a blood sample from an infant. The respiratory acidosis in the arterial sample is also mild, but there is also a mild metabolic acidosis. The standard technique of sampling cord blood for gas and acid-base analysis comprises three steps: clamping a segment of the cord removing the clamped cord segment needle aspiration of two blood samples (one venous, one arterial) from the excised clamped cord segment into preheparinized syringes 1. . This makes good sense if there is a period of time preceding total venous occlusion when the blood in the umbilical vein is slowed rather than halted. The pH, base excess and pCO2 (acid-base status) of arterial blood flowing through the umbilical cord provides valuable objective evidence of the metabolic condition of neonates at the moment of birth; a notion that has assured a role for the blood gas analyzer in hospital delivery suites in cases of suspected fetal distress/asphyxia. Your practical guide to critical parameters in acute care testing. Analyzing cord blood gas levels is often the best indicator of hypoxia or ischemia during the delivery period. Our specific aim was to develop a standardized clinical care pathway, ensuring timely identification and evaluation of neonates with umbilical-cord acidemia at risk for HIE.METHODS. Cap both ends and mix 20 times by gentle inversion. There are wide ranges of umbilical cord gas values which can be considered normal. The placenta is an organ which is attached to the inside of the uterine wall and connects the fetus through the umbilical cord and allows for nutrient exchange, waste elimination and gas exchange via the mothers blood supply. Based on the Siggard-Andersen Acid-Base Alignment Nomogram, this handy chart allows you to comfortably interpret a neonatal blood gas result in seconds. Eventual outcome depends on severity/site of brain injury; those with mild HIE survive with usually little or no long-term consequences, but most of those with moderate/severe HIE either die during the neonatal period or survive with severe and permanent neuro/psychological deficit, cerebral palsy is an outcome for some [8, 9]. Umbilical-cord acidemia may indicate perinatal asphyxia and places a neonate at increased risk for hypoxic ischemic encephalopathy (HIE). The standard technique of sampling cord blood for gas and acid-base analysis comprises three steps: The purpose of cord blood gas analysis is to determine the acid-base status of the neonate at the moment of delivery. An arterial blood gas is a laboratory test to monitor the patient's acid-base balance. Waiting even 45 seconds will skew the results due to chemicals changing in the artery. PCO2 measures the amount of carbon dioxide gas dissolved in the blood, and PO2 measures how much oxygen is in the blood. pH is a measure of acidity or alkalinity of any solution. Wyckoff MH, Perlman JM, Laptook AR. I am so grateful that I was lucky to pick Miller & Zois. 2016, Medications. The change is a progressive decrease in pH and base excess, and increase in, The lack of consensus on this issue among national expert bodies is reflected in obstetric practice around the world; some obstetric units having a selective policy, whilst others are routinely performing cord blood gas analysis at all births. Terminology and normal arterial blood gases . Although the quality and reliability of the blood gas instruments have improved dramatically, constant vigilance still is required and mandated to ensure accurate and precise results. The placenta uses gas exchange to supply them with oxygen that comes from the mother's blood. A recent Cochrane review of study in this area concluded that the benefit to the baby associated with delayed clamping (higher birthweight, increased hemoglobin concentration and iron reserves) outweighs the small increased risk of jaundice, stating that a more liberal approach to delayed clamping is warranted [23]. Acidosis with nuchal cords and normal Apgar scores. Apgar scores were 6 and 9 at one and five minutes, respectively. not associated with metabolic acidosis) at birth is indicative of impaired gas exchange and consequent reduced oxygen delivery to the fetus. Oxygenated blood from the mother diffuses into capillaries in the placenta and the vein into the umbilical cord, specifically into the umbilical vein, which picks up this oxygenated blood from the capillaries, and carries it to the babys heart, which pumps the blood throughout the babys body. KQ . During labor, the FHR monitor revealed recurrent variable decelerations that were deeper and longer-lasting, and then a deceleration to 60 bpm for three minutes. There are many reasons as to why a baby would have normal blood cord gases despite suffering from a hypoxic brain injury. The P o2 and P co2 values can provide further clues to the interpretation of the clinical picture and helps to exclude rogue results. The capillaries will then deliver the blood to the placenta's main artery where it is finally transferred to the baby. ABG analysis can be easy! Benirschke and Kaufman (10) have observed that cord compression (presumably cord occlusion followed by terminal fetal bradycardia) leads to congestion in the terminal capillaries and an increase in villous blood volume, sometimes by more than 50%. The hallmark of cord occlusion with terminal bradycardia is widened venoarterial pH, PCO2, and sometimes base deficit differences, usually associated with normal or near-normal umbilical venous cord gases. Value: Normal Range: Abnormal Values: pH. Blood is a body fluid that delivers vital substances . Arterial blood gases (ABGs) are commonly used for estimating the acid-base status, oxygenation and carbon dioxide concentration of unwell patients. Interpreting Arterial Cord Blood Gas Values. placental infarction/dysfunction marked by intrauterine growth restriction, oligohydramnios or abnormal Doppler studies, significant anemia due to isoimmunization, maternal fetal bleed or vasa previa, carboxy- hemoglobinemia (if mother is a smoker), Westgate J, Garibaldi J, Greene K. Umbilical cord blood gas analysis at delivery: a time for quality data. Indeed, most (around 75 %) babies with significant metabolic acidosis (pH <7.0, base excess. On your arrival, the patient appears drowsy and is on 10L of oxygen via a mask. National clinical guidelines in the UK [26], endorsed by the Royal College of Obstetricians and Gynaecologists, suggest a selective approach, in stating that Paired cord blood gases do not need to be taken routinely. This calculator only differentiates between acute (pH abnormal) and compensated (pH normal). LL . Obstet Gynecol 1984; 63: 44-47, Valero J, Desantes D, Perales-Pulchat A. The policy of delayed cord clamping clearly poses a potential problem for accurate assessment of neonatal acid-base status at birth, because of the hidden acidosis phenomenon. However, arterial blood can be difficult to obtain due to weak pulses or patient movement. If a baby has acidosis, you will see poor cord gases at birth. From an obstetrics perspective, these can be challenging to really interpret, but the simple interpretation is often worth some CREOG points if you can analyze these systematically. Effect of delayed umbilical cord clamping on blood gas analysis. The pH, PCO2, and base deficit change quite slowly in a completely occluded umbilical vessel, likely because much of the surrounding tissue (Wharton's jelly) has very little metabolic activity and accordingly utilizes very little oxygen and produces very little carbon dioxide. A difference between base deficits of four or more should suggest umbilical cord occlusion with terminal fetal bradycardia (or much more rarely, fetal heart failure). Dunn PM. Interpreting umbilical cord blood gases and detecting birth asphyxia The most important measurements in a blood gas test for evaluating a baby's current condition and prognosis are the pH and the base deficit. In Geneva in 1821, a French nobleman Jacques Alexandre Le Jumeau, Vicomte de Kergaradec, became the Apgar scores and umbilical artery pH have traditionally been used as objective measures of 2022 Radiometer Medical ApS | kandevej 21 | DK-2700 | Brnshj | Denmark | Phone +45 3827 3827 | CVR no. 1.37 = Milliliters of oxygen bound to 1 g of hemoglobin at 100 percent saturation Hb = Hemoglobin concentration (g/dl) SaO 2 = Percent of hemoglobin bound to oxygen (%) 0.03 = Solubility factor of oxygen in plasma (ml/mm Hg) PaO 2 = Oxygen partial pressure in arterial blood (mm Hg) Wykoff M, Garcia D, Margraf L, Perlman J, et al. Unfortunately it is more difficult to sample arterial than venous cord blood because umbilical arteries are much smaller and less visible than umbilical veins [20]. New York, Springer-Verlag; 1990, p91. In: McLaren A (ed): Advances in reproductive physiology. The "P" in PO2 and PCO2 means "partial pressure", which is how the cord blood gases are measured. The general goals of oxygen therapy in the neonate are to maintain adequate arterial P a O 2 and S a O 2, and to minimize cardiac work and the work of . Learn more about Obiehere. It is good to refreshed my knowledge about how to interpreter a blood gas result. Important issues surrounding cord blood sampling will also be discussed. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. Br J Obstet Gynaecol 1999;106:664-71. Adult arterial (non-cord) blood values (for comparison only). Blood Gas (Stewart) ICU Calculators-RNSH. The prevalence of metabolic acidosis can be used as an outcome measure for testing the efficacy of novel fetal monitoring strategies. Molar Solution Concentration Calculator. Normal arterial blood cord gases values in a full-term newborn: Normal blood cord gases levels in a preterm newborn: All values are 1 standard deviation. Umbilical venous pressure and Doppler flow pattern of inferior vena cava in the fetus. Understanding and use of blood gas analysis enable providers to interpret respiratory, circulatory, and metabolic disorders. Armstrong L, Stenson B. BE is the Base excess (SBE for Standar Base Excess). Although these arterial blood pressure measurements were taken in fetal sheep, they are thought to be a reasonable estimate for the human fetus. The interpretation of blood cord gas levels can also be used by malpractice lawyers and medical experts to show the severity of damage that occurred during delivery by citing the specific pH and base deficit levels. Randomized trial of volume infusion during resuscitation of asphyxiated neonatal piglets. Box 51-1 describes an umbilical cord blood gas sampling procedure. A VBG is obtained by placing a venous sample . Blood is sampled into a preheparinized syringe by needle aspiration. Studies have shown this is a vital component to determining the health of your baby. Metabolic acidosis is when there are high acid levels in the body that originated from impaired kidney function. Efficacy depends on initiating this hypothermic treatment within 6 hours of birth. The intrapartum acid-base status, the status of the oxygen and other gases in the fetus and the umbilical cord after birth is important in establishing the link between events before and shortly after delivery. The infant was then delivered by outlet forceps. This helps determine how well the infant is breathing and removing carbon dioxide from their body. Acta Obstrica Gynecol Scand 2012; 91: 574-79. Delay in clamping by as little as 45 seconds after birth results in significant change in acid-base parameters [13-15]; the longer the delay, the greater is the change [16, 17]. Correpondence of this manuscript should be addressed to: Case 10: Umbilical Cord Occlusion with Terminal Fetal Bradycardia, Mild. Saponification Value Calculator. Because of decreased fetal movement complaint three days before admission, a non-stress test was performed and was reactive, but had several mild, variable decelerations.