Universal Versus Selective Sampling of Umbilical Cord Gases in University-Based, Academic Community-Based, and Private Practice Settings: A Cross-Sectional Study

BackgroundUmbilical cord blood gas analysis provides an objective assessment of fetal metabolic status at delivery and may aid in identifying acute intrapartum hypoxic-ischemic events and newborns at risk for neurologic injury.However, there is no consensus regarding universal versus selective cord gas sampling, and professional society recommendations vary.This study aimed to evaluate differences in umbilical cord gas sampling practices, institutional protocols, and indications for sampling among obstetric providers across university-based, academic community, and private practice settings. MethodsAn anonymous survey was distributed to independent obstetric providers at hospitals with labor and delivery units throughout the greater Philadelphia region, including New Jersey, from September through December 2023.Eligible respondents included physicians (MD/DO) and certified nurse-midwives who independently managed deliveries.Respondents were categorized as practicing in university-based hospitals with residents, academic community hospitals with residents, or private practices without residents.The survey assessed demographics, knowledge of institutional protocols, individual practice preferences, and indications for cord gas sampling.Pairwise comparisons were performed among practice settings using Fisher's exact test for unordered categorical variables and Wilcoxon tests for ordinal variables. ResultsSeventy-eight providers responded, of whom 77 met inclusion criteria: 29 (37.7%)practiced in universitybased settings, 33 (42.9%) in academic community settings, and 15 (19.5%) in private practice.Universitybased providers were more likely to report the presence of an institutional cord gas protocol (p<0.01),favor universal cord gas sampling (p<0.05), and obtain cord gases in patients requiring fetal surveillance.Reported frequency of cord gas sampling differed significantly by practice setting, with the highest frequency in university-based hospitals, followed by academic community hospitals and private practices (p<0.05).Across practice settings, providers generally agreed that fetal growth restriction <3rd percentile, Category III fetal heart rate tracings, maternal substance use, and five-minute Apgar scores <7 were indications for cord gas sampling.No significant differences were identified in awareness of protocol specifics, institutional indications for sampling, or methods of cord gas procurement.University-based providers were more likely to report preemptively setting aside a segment of umbilical cord after delivery (p<0.001).Providers across all practice settings supported delayed cord clamping. ConclusionsUmbilical cord gas sampling practices and provider preferences vary significantly by practice setting, with university-based providers reporting greater use of cord gas sampling, greater awareness of institutional protocols, and stronger preference for universal sampling compared with academic community and private practice providers.Despite these differences, providers demonstrated agreement on several high-risk clinical indications for cord gas analysis.These findings highlight variability in current practice and identify areas of provider consensus that may help inform standardized criteria for selective cord gas sampling and future prospective studies comparing selective with universal sampling.