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Mosnino E, Michel AS, Messedi E, Kayem G, Pinton A. [Comparison of the measurement of lactate at the cord by hand-held devices approved for use during labor with a reference device]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:481-485. [PMID: 35288368 DOI: 10.1016/j.gofs.2022.02.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/12/2022] [Accepted: 02/13/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare two portable lactate devices, Lactate Scout and StatStrip Xpress, to a laboratory reference device by assessing the concordance of cord blood lactate values at birth. METHODS We conducted a single-center prospective validation study in a level 3 maternity hospital. For all cord samples taken at birth, we analyzed lactates on the reference device (GEM4000®) and on two portable devices Lactate Scout and StatStrip Xpress. We compared the lactate values from each of the two handheld devices to the reference device. RESULTS A total of 101 samples were collected. Each was analyzed by all three machines. The average lactate value obtained by the different machines was 3.7mmol/L. The mean difference between the Lactate Scout and GEM4000® apparatus was 0.0mmol/L±0.8mmol/L. Between these two devices at lactate threshold of 4.8mmol/L, the negative predictive value was 96,2% (76/79) and the area under the curve was 0.98 (95% CI 0.96-1]. The mean difference between StatStrip Xpress and GEM4000® was 0.1mmol/L±0.7mmol/L. Between these two devices at the lactate threshold of 4.8mmol/L, the negative predictive value was 97,4% (76/78) and the area under the curve was 0.95 (95% CI 0.86-1). CONCLUSION There is a good correlation between the lactates obtained by the reference device and the two portable devices Lactate Scout and StatStrip Xpress.
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Affiliation(s)
- E Mosnino
- Service de gynécologie obstétrique, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne Université, AP-HP, 91, boulevard de l'Hôpital, Paris, France
| | - A-S Michel
- Service de gynécologie obstétrique, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne Université, AP-HP, 91, boulevard de l'Hôpital, Paris, France
| | - E Messedi
- Sorbonne Université, AP-HP, 91, boulevard de l'Hôpital, Paris, France; Service de biochimie, hôpital Trousseau, DMU biologie et génomique Médicales, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - G Kayem
- Service de gynécologie obstétrique, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne Université, AP-HP, 91, boulevard de l'Hôpital, Paris, France
| | - A Pinton
- Service de gynécologie obstétrique, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne Université, AP-HP, 91, boulevard de l'Hôpital, Paris, France.
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Torres Yordán NC, Lewis AG, McElrath TF, Tolan NV, Greenberg JA. Point-of-care assessment of combined umbilical arterial and venous lactate: A potential screening test for neonatal acidosis. Int J Gynaecol Obstet 2021; 158:86-92. [PMID: 34610142 DOI: 10.1002/ijgo.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/18/2021] [Accepted: 10/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the relationship between point-of-care (POC) measurement of combined umbilical arterial and venous (CUAV) lactate and umbilical artery (UA) lactate to determine whether POC assessment of this sample could be an alternative screening modality for neonatal acidosis and aid prediction of neonatal morbidity. METHODS In this cross-sectional pilot study, UA and CUAV cord blood samples were collected from live, singleton neonates delivered between June and August 2019, at a tertiary care center. UA samples were analyzed for pH and lactate using a blood gas analyzer. CUAV lactate was also assessed on a blood gas analyzer and at the POC. Linear regression was used to determine the correlation between these samples. RESULTS A total of 152 neonates were included. There was a statistically significant correlation between CUAV lactate concentrations and UA lactate concentrations (R2 = 0.744). Additionally, CUAV lactate concentration measured at the POC was significantly correlated with that measured on a traditional blood gas analyzer (R2 = 0.928). CONCLUSION POC testing of CUAV lactate is reliable and closely correlated with UA lactate concentrations, making POC testing of CUAV lactate a potential screening test for neonatal acidosis. More data are needed to establish standardization of this test relative to its predictive value in clinical neonatal outcomes.
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Affiliation(s)
- Nora C Torres Yordán
- Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Thomas F McElrath
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole V Tolan
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - James A Greenberg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Iorizzo L, Carlsson Y, Johansson C, Berggren R, Herbst A, Wang M, Leiding M, Isberg PE, Kristensen K, Wiberg-Itzel E, McGee T, Wiberg N. Proposed cutoff for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a large prospective observational study. BJOG 2021; 129:636-646. [PMID: 34555249 DOI: 10.1111/1471-0528.16924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Determination of lactate in fetal scalp blood (FBS) during labour has been recognised since the 1970s. The internationally accepted cutoff of >4.8 mmol/l indicating fetal acidosis is exclusive for the point-of-care device (POC) LactatePro™, which is no longer in production. The aim of this study was to establish a new cutoff for scalp lactate based on neonatal outcomes with the use of the StatstripLactate® /StatstripXpress® Lactate system, the only POC designed for hospital use. DESIGN Observational study. SETTING January 2016 to March 2020 labouring women with indication for FBS were prospectively included from seven Swedish and one Australian delivery unit. POPULATION Inclusion criteria: singleton pregnancy, vertex presentation, ≥35+0 weeks of gestation. METHOD Based on the optimal correlation between FBS lactate and cord pH/lactate, only cases with ≤25 minutes from FBS to delivery were included in the final calculations. MAIN OUTCOME MEASURES Metabolic acidosis in cord blood defined as pH <7.05 plus BDecf >10 mmol/l and/or lactate >10 mmol/l. RESULTS A total of 3334 women were enrolled of whom 799 were delivered within 25 minutes. The areas under the receiver operating characteristics curves (AUC) and corresponding optimal cutoff values were as follows; metabolic acidosis AUC 0.87 (95% CI 0.77-0.97), cutoff 5.7 mmol/l; pH <7.0 AUC 0.83 (95% CI 0.68-0.97), cutoff 4.6 mmol/l; pH <7.05 plus BDecf ≥12 mmol/l AUC 0.97 (95% CI 0.92-1), cutoff 5.8 mmol/l; Apgar score <7 at 5 minutes AUC 0.74 (95% CI 0.63-0.86), cutoff 5.2 mmol/l; and pH <7.10 plus composite neonatal outcome AUC 0.76 (95% CI 0.67-0.85), cutoff 4.8 mmol/l. CONCLUSION A scalp lactate level <5.2 mmol/l using the StatstripLactate® /StatstripXpress® system will safely rule out fetal metabolic acidosis. TWEETABLE ABSTRACT Scalp blood lactate <5.2 mmol/l using the StatstripLactate® /StatstripXpress system has an excellent ability to rule out fetal acidosis.
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Affiliation(s)
- L Iorizzo
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Helsingborg Hospital, Helsingborg, Sweden
| | - Y Carlsson
- Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - C Johansson
- Department of Obstetrics and Gynaecology, Ystad lasarett, Ystad, Sweden
| | - R Berggren
- Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Herbst
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Skåne University Hospital, Skåne, Sweden
| | - M Wang
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - M Leiding
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Skåne, Sweden
| | - P-E Isberg
- Department of Statistics, Lund University, Lund, Sweden
| | - K Kristensen
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Qld, Australia
| | - E Wiberg-Itzel
- Department of Obstetrics and Gynaecology, Söder Hospital, Stockholm, Sweden.,Institute of Karolinska, Stockholm, Sweden
| | - T McGee
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - N Wiberg
- Department of Obstetrics and Gynaecology, Ystad lasarett, Ystad, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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