Use of Lactate ProTM2 for measurement of fetal scalp blood lactate during labor - proposing new cutoffs for normality, preacidemia and acidemia: a cross-sectional study

Fetal monitoring technologies for the detection of intrapartum hypoxia - challenges and opportunities

Intrapartum fetal hypoxia is related to long-term morbidity and mortality of the fetus and the mother. Fetal surveillance is extremely important to minimize the adverse outcomes arising from fetal hypoxia during labour. Several methods have been used in current clinical practice to monitor fetal well-being. For instance, biophysical technologies including cardiotocography, ST-analysis adjunct to cardiotocography, and Doppler ultrasound are used for intrapartum fetal monitoring. However, these technologies result in a high false-positive rate and increased obstetric interventions during labour. Alternatively, biochemical-based technologies including fetal scalp blood sampling and fetal pulse oximetry are used to identify metabolic acidosis and oxygen deprivation resulting from fetal hypoxia. These technologies neither improve clinical outcomes nor reduce unnecessary interventions during labour. Also, there is a need to link the physiological changes during fetal hypoxia to fetal monitoring technologies. The objective of this article is to assess the clinical background of fetal hypoxia and to review existing monitoring technologies for the detection and monitoring of fetal hypoxia. A comprehensive review has been made to predict fetal hypoxia using computational and machine-learning algorithms. The detection of more specific biomarkers or new sensing technologies is also reviewed which may help in the enhancement of the reliability of continuous fetal monitoring and may result in the accurate detection of intrapartum fetal hypoxia.

Neuromuscular and balance adaptations following basketball-specific training programs based on combined drop jump and multidirectional repeated sprint versus multidirectional plyometric training

Multidirectional jumping and repeated sprint ability are crucial performance factors in basketball. The main aim of this investigation was to examine the neuromuscular performance and body balance adaptations following basketball-specific combined training programs based on drop jump and multidirectional repeated sprint versus multidirectional plyometric training. Forty-two professional basketball male players participated in the current investigation and were randomly assigned to three groups: a combined group (COMB; n = 14), a multidirectional jump group (MJG; n = 14) and an active control group (CON; n = 14). The COMB and the MJG groups completed the 8-week training programs with two weekly sessions while the CON continued their usual training. The static and dynamic balance tests, the repeated sprint ability test (IRSA5COD), the T-change of direction (CoD) test, the vertical jump tests, the five time-jump test (FJT) were performed by participants before and after the intervention period. The results showed a significant main effect of time with remarkable improvements at the end of the intervention (P < 0.001, effect size small/moderate) except the physiological parameters for IRSA5COD. Only, significant group × time interactions for body balance, T-CoD test, IRSA5COD (total time and best time), and jump tests were found (P < 0.001, effect size from trivial to moderate). Bonferroni corrected post-hoc tests revealed significantly greater improvement in favor of COMB compared to MJG for body balance, CoD and IRSA5COD (P < 0.005, effect size small/moderate). Otherwise, no significant differences between COMB and MJG concerning jump performances were found. Combined drop jump and multidirectional repeated sprint training program lead to significantly better neuromuscular performance, body balance and CoD in professional basketball players when compared with an usual training.

Impact of combined versus single-mode training programs based on drop jump and specific multidirectional repeated sprint on bio-motor ability adaptations: a parallel study design in professional basketball players

Background

Jumping and specific multidirectional repeated sprint ability are important in basketball. The objective of this study was to assess the contributions of 8-week combined versus single-mode training programs based on drop jump (DJ) and specific multidirectional repeated sprint (MRSA) on repeated sprint ability performances, body balance and lower limbs power in male professional basketball players.

Methods

This study followed a randomized parallel study design. Fifty-two professional male basketball players from the Tunisian first division participated in this study. The players were randomly assigned to 4 groups: DJ group (JG; n = 13), MRSA group (RSG; n = 13), combined group (COMB; n = 13) and an active control group (CON; n = 13). The JG, RSG and COMB groups completed the 8-week training programs with 2 sessions per week while the CON continues their regular basketball training. Training volume was similar between groups all over the experimental period. Before and after the intervention, the four groups were evaluated for the stork test, Y-balance test, the repeated sprint ability test (IRSA_5COD), the squat jump (SJ) and countermovement jump (CMJ) tests, the single leg drop jump test, the five time-jump test and T—change of direction (CoD) test.

Results

All measures displayed significant main effect, (medium/small) magnitude (effect size) improvements for time (post-test > pre-test) except the physiological parameters for IRSA_5COD. Significant time × group interactions were revealed for body balance, T test, IRSA_5COD (total time and best time) and jump tests (vertical/horizontal). Bonferroni corrected post-hoc tests revealed significant greater improvement in favor of RSG and COMB compared to JG for body balance, CoD and IRSA_5COD. Moreover, greater improvement in CMJ, SJ and single leg DJ in favor of JG compared to the RSG. In addition, a greater CoD improvement was observed in favor of COMB when compared to the RSG.

Conclusion

Combined and single-mode training programs based on DJ and MRSA contributed to a significantly better performance in specific basketball physical fitness parameters with results favoring combined interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-022-00551-w.

[Comparison of the measurement of lactate at the cord by hand-held devices approved for use during labor with a reference device]

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.

Construct Validity and Reliability of a New Basketball Multidirectional Reactive Repeated Sprint Test

The objective of this study was to investigate the construct validity and reliability of a new reactive multidirectional repeated sprinting test (RRSA_5COD) in basketball players. Forty male basketball players were divided into two groups: Professional (PRO; n = 20) and Semi-professional (SEMI; n = 20). Participants completed the yo-yo intermittent recovery test level 1 (Yo-YoIR1), the squat jump (SJ), the counter movement jump (CMJ), the single leg drop jump (DJ), the 20-m sprint test, the planed multidirectional repeated sprinting test (PRSA_5COD), and the RRSA_5COD test. Reaction time (RT) and movement time (MT), total time (TT), best time (BT), and fatigue index (FI) were assessed. Heart rate (HR) was continuously recorded, while rating of perceived exertion (RPE) and blood lactate concentration (LA) were measured post-tests. The reliability of the RRSA_5COD test was also assessed between two attempts with one week between them. The RRSA_5COD results demonstrated to be reliable with most of the variables showing ICC > 0.80. BA Bonferroni post hoc revealed a significant better TT in favor of RRSA_5COD (p < 0.001; ES = 0.15; small), and in favor of PRO (p < 0.001; ES = 0.006; small). The result showed a significant better performance in favor of PRO in all physical fitness tests. In conclusion, it was found that the RRSA_5COD discriminates between professional and semi-professional male basketball players, and the results were demonstrated to be reliable.

Proposed cutoff for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a large prospective observational study

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 BD_ecf >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 BD_ecf ≥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.

Convergent validity of a simplified device and relationship between blood lactate and salivary lactate after a vertical squat jump in healthy non-athletes

[Purpose] The aims of this study were 1) to examine the convergent validity between Lactate pro 2 and a standard JCA-BM 8000 automatic analyzer using salivary lactate and 2) to investigate the relationship between blood and salivary lactate levels after a vertical squat jump. [Participants and Methods] Healthy non-athletes participated in this observational study. The participants performed a vertical squat jump for 1 min 30 s. Blood and salivary lactate levels were measured before and after exercise using Lactate Pro 2. [Results] The intraclass correlation coefficient between Lactate Pro 2 and the JCA-BM 8000 automatic analyzer was 0.773, which can be considered as substantial convergent validity. However, in some samples, the salivary lactate level was out of the measurable range, and numerical values could not be obtained. The cross-correlation function between the blood and salivary lactate levels was 0.535 at lag 0 and 0.750 at lag 1, which indicated a 5-min lag between the salivary and blood lactate values. [Conclusion] Salivary lactate levels can be easily measured using Lactate Pro 2, although its sensitivity needs to be resolved. Further research is required for salivary lactate level, which can be collected non-invasively, to be used as an alternative parameter to blood lactate level.

Effectiveness of fetal scalp stimulation test in assessing fetal wellbeing during labor, a retrospective cohort study

BACKGROUND

It is discussed whether fetal scalp stimulation (FSS) test is a reliable complimentary tool to cardiotocography (CTG) to assess fetal wellbeing during labor. The test is based on the assumption that a well-oxygenated fetus, in contrast to the depressed fetus, will respond to a certain stimulus. The aim of this study was to investigate the effectiveness of the FSS-test.

METHODS

A retrospective observational study carried out Copenhagen University Hospital, Herlev, Denmark. Laboring women with singleton pregnancies in cephalic presentation after gestation week 33 and indication for fetal blood sampling (FBS) were eligible for inclusion. The FSS-test was classified as positive when an acceleration was absent at the time of FBS and negative when an acceleration was present. Lactate in scalp blood was measured by the point-of-care device LactatePro™ and pH in artery umbilical cord blood by the stationary blood gas analyzer ABL800. Lactate level < 4.2 mmol/L in scalp blood and arterial cord pH > 7.1 were cut-offs for normality.

RESULTS

Three hundred eighty-five women were included. The cohort was divided by the FBS-to-delivery time: Group 1 (n = 128) ≤ 20 min, Group 2 (n = 117) 21-59 min and Group 3 (n = 140) ≥ 60 min. The proportion of FSS-positive tests differed significantly between the groups (p < 0.000). In Group 1 the sensitivity, specificity and likelihoods for scalp lactate ≥4.2 mmol/L were 81.5 (95% CI 67-90.1), 13.3 18.5 (95% CI 5.9-24.6), LHR+ 0.94 (95% CI 0.8-1.1) and LHR - 1.4 (95% CI 0.6-3.2) and for umbilical artery pH ≤ 7.10 the values were 82.6% (95% CI 61.2-95.1), 16% (95% CI 9.4-24.7), 1.0 (95% CI 0.8-1.2) and 1.1 (95% CI 0.4-3) respectively. Regardless of the FBS-to-delivery time the LHR+ for lactate ≥4.2 mmol/L increased to 1.38 (95% CI 1.2-1.6).

CONCLUSION

The effectiveness of scalp stimulation test was poor for both ruling in and out fetal hypoxia during labor. Absence of a provoked acceleration seems to be a normal phenomenon in the second stage of labor.

Comparison of cord blood lactate measurement by gas analyzer and portable electrochemical devices

Objective To compare the accuracy of cord blood lactate measurement using gas analyzer and portable devices in order to assess possibility of implementation of these devices in clinical practice. Methods We performed a prospective observational study using 30 umbilical cord samples which were obtained immediately after birth. Portable electrochemical devices Lactate Scout (SensLab GmbH, Leipzig, Germany) and StatStrip Lactate (NOVA Biomedical, Waltham, MA, USA) were used to determine lactate level. A gas analyzer ABL800 FLEX (Radiometer Medical ApS, Brønshøj-Husum, Denmark) was used as a reference. Base excess (BE), pH, partial oxygen (pO2) and carbon dioxide (pCO2) pressure, hemoglobin (ctHb) and bilirubin (ctBl) levels were measured. Results The mean umbilical cord blood lactate level determined by the gas analyzer was 5.85 ± 2.66 mmol/L (ranging from 1.4 mmol/L to 13.4 mmol/L). Lactate level estimated by Lactate Scout was 5.66 ± 2.65 mmol/L and did not significantly differ from the reference method level (P = 0.2547). The mean lactate level determined by StatStrip Lactate was significantly lower than by the gas analyzer - 4.81 ± 2.38 mmol/L (P < 0.0001). Umbilical cord blood pH, BE, pO2 and pCO2, ctHb and ctBl levels did not affect the accuracy of the lactate measurement in absolute units (mmol/L). Conclusion Umbilical cord blood lactate level measured by StatStrip Lactate was lower than estimated by the ABL800 FLEX gas analyzer. This shows the necessity to develop decision-making reference points separately for each device. Umbilical cord blood pH, BE, pO2 and pCO2, ctHb and ctBl levels did not affect the accuracy of measurements by electrochemical portable devices.