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Musaba MW, Nambozo B, Mukunya D, Wandabwa J, Barageine JK, Kiondo P, Napyo A, Sserwanja Q, Weeks AD, Tumwine JK, Ndeezi G. Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial. BMC Pediatr 2023; 23:179. [PMID: 37072754 PMCID: PMC10111771 DOI: 10.1186/s12887-023-04008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/12/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND In high resource settings, lactate and pH levels measured from fetal scalp and umbilical cord blood are widely used as predictors of perinatal mortality. However, the same is not true in low resource settings, where much of perinatal mortality occurs. The scalability of this practice has been hindered by difficulty in collecting fetal scalp and umbilical blood sample. Little is known about the use of alternatives such as maternal blood, which is easier and safer to obtain. Therefore, we aimed to compare maternal and umbilical cord blood lactate levels for predicting perinatal deaths. METHODS This was secondary analysis of data from a randomized controlled trial assessing the effect of sodium bicarbonate on maternal and perinatal outcomes among women with obstructed labour at Mbale regional referral hospital in Eastern Uganda. Lactate concentration in maternal capillary, myometrial, umbilical venous and arterial blood was measured at the bedside using a lactate Pro 2 device (Akray, Japan Shiga) upon diagnosis of obstructed labour. We constructed Receiver Operating Characteristic curves to compare the predictive ability of maternal and umbilical cord lactate and the optimal cutoffs calculated basing on the maximal Youden and Liu indices. RESULTS Perinatal mortality risk was: 102.2 deaths per 1,000 live births: 95% CI (78.1-130.6). The areas under the ROC curves were 0.86 for umbilical arterial lactate, 0.71 for umbilical venous lactate, and 0.65 for myometrial lactate, 0.59 for maternal lactate baseline, and 0.65 at1hr after administration of bicarbonate. The optimal cutoffs for predicting perinatal death were 15 0.85 mmol/L for umbilical arterial lactate, 10.15mmol/L for umbilical venous lactate, 8.75mmol/L for myometrial lactate, and 3.95mmol/L for maternal lactate at recruitment and 7.35mmol/L after 1 h. CONCLUSION Maternal lactate was a poor predictor of perinatal death, but umbilical artery lactate has a high predictive value. There is need for future studies on the utility of amniotic fluid in predicting intrapartum perinatal deaths.
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Affiliation(s)
- Milton W Musaba
- Department of Obstetrics and Gynaecology, Busitema University/ Mbale Regional Referral and Teaching Hospital, Mbale, Uganda.
| | | | - David Mukunya
- Sanyu Africa Research Institute, Mbale, Uganda
- Department of Public and Community Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Julius Wandabwa
- Department of Obstetrics and Gynaecology, Busitema University/ Mbale Regional Referral and Teaching Hospital, Mbale, Uganda
| | - Justus K Barageine
- Department of Obstetrics & Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul Kiondo
- Department of Obstetrics & Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Napyo
- Department of Public and Community Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | | | - Andrew D Weeks
- Department of Obstetrics and Gynaecology, Busitema University/ Mbale Regional Referral and Teaching Hospital, Mbale, Uganda
- Sanyu Africa Research Institute, Mbale, Uganda
- Sanyu Research Unit, University of Liverpool, University of Liverpool/Liverpool Women's Hospital, Liverpool, UK
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Prouhèze A, Girault A, Barrois M, Lepercq J, Goffinet F, Le Ray C. Fetal scalp blood sampling: Do pH and lactates provide the same information? J Gynecol Obstet Hum Reprod 2020; 50:101964. [PMID: 33130281 DOI: 10.1016/j.jogoh.2020.101964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Assess the discordance between scalp pH and lactates performed from the same sample during labor. METHOD This single-center retrospective study included all women with a singleton fetus who had at least one fetal blood sample taken during labor. Some of them had up to seven samples. Scalp pH was the reference parameter for obstetric decision-making. The correlation between the pH and lactates was studied using Pearson coefficient. By categorizing the values as normal, pre-acidosis and acidosis, we were able to estimate agreement with Cohen's kappa coefficient. The frequency of discordance in the categorization and the factors related to it were studied with univariate and multivariable analyses. Cases of severe acidosis at birth (cord pH < 7.00) and cases with acidosis scalp lactates but normal scalp pH were analyzed. RESULTS We analyzed 480 samples from 268 fetuses among the 2644 deliveries during the study periode. Fetal blood sampling represented 10 % of deliveries. The scalp pH and lactates results were strongly correlated (r=-0.83), but their agreement was only fair (K = 0.36). In 29.4 % of cases, pH and lactates were discordant. Factors related to discordance were meconium-stained fluid, sampling at full dilation and multiple sampling. Six infants (2.2 %) had severe acidosis at birth. Cases' analyses did not allow to conclude severe acidosis could have been avoided using scalp lactates for obstetric decision-making. CONCLUSION For more than a quarter of the samples, results were discordant between scalp pH and lactates, especially when cervix was full dilated and when the amniotic fluid was meconium-stained. A randomized controlled trial comparing the relevance of each parameter according to the obstetrical situation would be necessary.
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Affiliation(s)
- Audrey Prouhèze
- Maternity of Port-Royal, AP-HP. APHP., Paris University Center, FHU PREMA, Paris, France.
| | - Aude Girault
- Maternity of Port-Royal, AP-HP. APHP., Paris University Center, FHU PREMA, Paris, France; Paris University, INSERM U1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research on Epidemiology and Statisctics Sorbonne Paris Cité (CRESS), Paris, France
| | - Mathilde Barrois
- Maternity of Port-Royal, AP-HP. APHP., Paris University Center, FHU PREMA, Paris, France
| | - Jacques Lepercq
- Maternity of Port-Royal, AP-HP. APHP., Paris University Center, FHU PREMA, Paris, France
| | - François Goffinet
- Maternity of Port-Royal, AP-HP. APHP., Paris University Center, FHU PREMA, Paris, France; Paris University, INSERM U1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research on Epidemiology and Statisctics Sorbonne Paris Cité (CRESS), Paris, France
| | - Camille Le Ray
- Maternity of Port-Royal, AP-HP. APHP., Paris University Center, FHU PREMA, Paris, France; Paris University, INSERM U1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research on Epidemiology and Statisctics Sorbonne Paris Cité (CRESS), Paris, France
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Labrecque L, Provençal M, Caqueret A, Wo BL, Bujold E, Larivière F, Bédard MJ. Correlation of cord blood pH, base excess, and lactate concentration measured with a portable device for identifying fetal acidosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 36:598-604. [PMID: 25184978 DOI: 10.1016/s1701-2163(15)30539-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the effectiveness of portable lactate analyzers in identifying fetal acidosis by correlating arterial and venous lactate values from umbilical cord blood with lactate, pH, and base excess measurements from central laboratory analyzers. METHODS We performed a prospective study using arterial and venous cord blood from 52 women with a singleton fetus delivered at term. We evaluated the correlation between the cord blood lactate concentration measured using two of the same portable devices (Lactate Plus, Nova Biomedical) with the result from a central laboratory analyzer. Analyses of the correlation between arterial lactate concentration measured on the portable device with arterial pH and base excess were then performed. RESULTS We observed a median arterial pH of 7.24 (range 7.05 to 7.35) and a median arterial lactate concentration of 3.7 mmol/L (range 1.7 to 8.8 mmol/L). An excellent correlation was observed between lactate concentrations measured by the two portable devices (arterial R² = 0.98 and venous R² = 0.98), and between the portable device and the central laboratory analyzer (arterial R² = 0.94 and venous R² = 0.95). In our population, the optimal cut-offs to predict a pH < 7.20 or a base excess > -8.0 mmol/L were a lactate concentration of 4.9 mmol/L and 5.3 mmol/L, respectively, according to receiver operator characteristic analysis. With a lactate concentration > 4.9 mmol/L, the portable device had a sensitivity of 82% and a specificity of 90% to identify samples with an arterial pH < 7.20. CONCLUSION Cord blood lactate concentration measured with a portable device is a good predictor of cord blood base excess and pH. Future studies should be designed to correlate scalp blood lactate measurements with clinical outcomes.
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Affiliation(s)
- Lyne Labrecque
- Department of Biochemistry, Centre hospitalier de l'Université de Montréal, Montreal QC
| | - Mathieu Provençal
- Department of Biochemistry, Centre hospitalier de l'Université de Montréal, Montreal QC
| | - Aurore Caqueret
- Department of Biochemistry, Centre hospitalier de l'Université de Montréal, Montreal QC
| | - Bi Lan Wo
- Department of Obstetrics and Gynecology, Centre hospitalier de l'Université de Montréal, Montreal QC
| | - Emmanuel Bujold
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec QC
| | - François Larivière
- Department of Biochemistry, Centre hospitalier de l'Université de Montréal, Montreal QC
| | - Marie-Josée Bédard
- Department of Obstetrics and Gynecology, Centre hospitalier de l'Université de Montréal, Montreal QC
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Hall B, Wong DD, Rawlinson WD, Tracy MB, Tracy SK. A validation study: assessing the reliability of the hand held StatStripXPress lactate meter to test lactate in amniotic fluid. BMC Res Notes 2014; 7:935. [PMID: 25523193 PMCID: PMC4300832 DOI: 10.1186/1756-0500-7-935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The level of lactate in amniotic fluid may provide useful clinical information when assessing whether a woman in labour is experiencing labour dystocia. If so, a rapid, reliable method to assess the concentration of amniotic fluid lactate at the bedside will be required in order to be clinically relevant. To assess efficacy, we compared the hand held StatStripXPreass lactate meter (Nova Biomedical) to the reference laboratory analyser ABX Pentra 400 (Horiba) in a controlled environment. Baseline biological lactate concentration was measured in triplicate and samples of a known quantity of thawed amniotic fluid spiked with lactate substrate (62 mmol/L) from the LDH12 kit (Roche, SUI) to yield a predetermined lactate concentration above baseline then measured in triplicate. Deming Regression was used to determine the linear agreement and a Bland Altman plot used to determine the paired agreement across the range of values. FINDINGS The mean difference with Bland-Altman plot between hand held meter and lab instrument was -1.0 mmol/L (SD 3.0 mmol/L) with 95% CI limits of agreement between -6.9 mmol/L to 4.9 mmol/L. The Deming regression co-efficient or slope of agreement was 0.91 (SD of 0.21). CONCLUSION The measurement of amniotic fluid lactate using the StatStripXPress hand held meter was reliable compared to reference laboratory methods for measuring lactate levels in amniotic fluid.
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Affiliation(s)
- Beverley Hall
- University of Sydney, Camperdown, Sydney, New South Wales 2006, Australia.
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Hall B, Iwasenko J, Moriatis M, Rawlinson WD, Tracy MB, Tracy SK. A pilot study to determine the feasibility of collecting amniotic fluid samples from women during labour and measuring amniotic fluid lactate at point of care. BMC Res Notes 2013; 6:112. [PMID: 23531401 PMCID: PMC3618323 DOI: 10.1186/1756-0500-6-112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 03/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background The level of lactate in amniotic fluid may provide useful clinical information when assessing progress of a woman’s labour and if so, a rapid, reliable method to assess amniotic fluid lactate is required in order to be clinically relevant. However, measuring lactate levels in amniotic fluid, using portable, handheld lactate meters may be less accurate than reference laboratory instruments designed to measure lactate levels in aqueous solutions. Prior to conducting a large study, we assessed recruitment, consent and sampling procedures, and the accuracy of a handheld lactate meter to measure lactate in amniotic fluid. We compared amniotic fluid lactate results obtained using the hand held Lactate Pro (Arkray) to results obtained using reference laboratory methods ABX Pentra 400 (Horiba). Results We recruited 35 nulliparous women during their antenatal hospital visits and tested amniotic fluid samples collected from 20 labouring women. The handheld Lactate Pro meter was found accurate from 9–20 mmol/L with a Passing & Bablok regression of y = 0.18 + 0.97x (95% CI 0.76–1.45). Amniotic fluid lactate results remained reliable in the presence of potential contaminants commonly encountered during labour; obstetric lubricant, blood and meconium. Conclusion The measurement of amniotic fluid lactate using the Lactate Pro meter was reliable compared to reference laboratory methods for measuring lactate levels in amniotic fluid. The pilot study enabled the refinement of information, recruitment, consenting and sampling procedures prior to commencing a large cohort study.
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Affiliation(s)
- Beverley Hall
- University of Sydney, Darlington, NSW 2006, Australia.
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Heinis AMF, Dinnissen J, Spaanderman MEA, Lotgering FK, Gunnewiek JMTK. Comparison of two point-of-care testing (POCT) devices for fetal lactate during labor. Clin Chem Lab Med 2011; 50:89-93. [PMID: 21955187 DOI: 10.1515/cclm.2011.734] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/09/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND Point-of-care testing (POCT) of fetal scalp blood lactate is used as an alternative for pH analysis. Lactate measurements have not been standardized and values vary with each device used. The aim of this study was to evaluate the performance of two POCT lactate meters for intrapartum use. METHODS Analytical performance of StatStrip Lactate (Nova Biomedical) and Lactate Pro (Arkray) was evaluated using CLSI EP10. Both POCT meters were compared with our lactate reference method (RapidLab 860; Siemens Healthcare Diagnostics) using fetal scalp and neonatal cord blood. Deming regression analysis was performed. RESULTS StatStrip Lactate coefficients of variation (CVs) were 5.1%, 5.0% and 2.6% at 0.9, 7.5 and 14.1 mmol/L lactate, respectively. CVs for Lactate Pro were 10.7%, 5.2% and 5.7% at 1.7, 4.1 and 6.4 mmol/L lactate, respectively. Consecutive lactate measurements in 37 fetal scalp and 122 cord blood samples revealed different test characteristics for the two POCT devices. In fetal scalp blood: StatStrip Lactate=1.13*RapidLab-0.39 (R(2)=0.907) and Lactate Pro=0.95*RapidLab-0.03 (R(2)=0.823). In cord artery blood: StatStrip Lactate=1.08*RapidLab-0.09 (R(2)=0.810) and Lactate Pro=0.72*RapidLab+0.59 (R(2)=0.807). CONCLUSIONS Overall performance of both Lactate Pro and StatStrip Lactate was good, with StatStrip Lactate having smallest CVs and closest correlation to our reference method. Both StatStrip Lactate and Lactate Pro can be used as a lactate POCT device for obstetric use.
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Affiliation(s)
- Ayesha M F Heinis
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, The Netherlands
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Ridenour RV, Gada RP, Brost BC, Karon BS. Comparison and validation of point of care lactate meters as a replacement for fetal pH measurement. Clin Biochem 2008; 41:1461-5. [DOI: 10.1016/j.clinbiochem.2008.08.088] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 08/18/2008] [Accepted: 08/25/2008] [Indexed: 11/24/2022]
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Umbilical cord blood lactate: a valuable tool in the assessment of fetal metabolic acidosis. Eur J Obstet Gynecol Reprod Biol 2007; 139:16-20. [PMID: 18063469 DOI: 10.1016/j.ejogrb.2007.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 09/19/2007] [Accepted: 10/12/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of the present study was (1) to evaluate the relationship between umbilical cord arterial blood lactate and pH, standard base excess (SBE), and actual base excess (ABE) at delivery and (2) to suggest a cut-off level of umbilical cord arterial blood lactate in predicting fetal asphyxia using ROC-curves, where an ABE value less than -12 was used as "gold standard" for significant intrapartum asphyxia. STUDY DESIGN This is a descriptive study of umbilical cord arterial blood samples from 2554 singleton deliveries. The deliveries took place at the Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Copenhagen, Denmark where umbilical cord blood sampling and blood gas analysis is part of the routine assessment of all newborns. RESULTS We found significant correlations between lactate and pH (r=-0.73), lactate and SBE (r=-0.76), and lactate and ABE (r=-0.83). ROC-curves suggested a lactate cut-off level of 8mmol/l for indicating intrapartum asphyxia. CONCLUSION Lactate in arterial umbilical cord blood might be a more direct and accordingly more correct indicator of fetal asphyxia at delivery than pH and SBE (or ABE). Its potential as a predictor of neonatal outcome needs to be evaluated in future studies.
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Morel O, Richard F, Thiébaugeorges O, Malartic C, Clément D, Akerman G, Barranger E. pH au scalp fœtal : intérêt pratique en salle de naissance. ACTA ACUST UNITED AC 2007; 35:1148-54. [DOI: 10.1016/j.gyobfe.2007.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 08/03/2007] [Indexed: 10/22/2022]
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Wiberg-Itzel E, Pettersson H, Cnattingius S, Nordstrom L. Association between lactate in vaginal fluid and time to spontaneous onset of labour for women with suspected prelabour rupture of the membranes. BJOG 2006; 113:1426-30. [PMID: 17010116 DOI: 10.1111/j.1471-0528.2006.01088.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess whether lactate determination in vaginal fluid is associated with, and can predict, onset of labour for women with suspected prelabour rupture of the membranes (PROM). DESIGN Prospective observational study. SETTING Labour ward at Soder Hospital, Stockholm, Sweden. POPULATION Women with suspected PROM after 34 weeks of gestation, who later had spontaneous onset of labour (n = 179). METHODS All women underwent a speculum examination and a test for determining lactate concentration in vaginal fluid. We used logistic regression to estimate the association between lactate concentration in vaginal fluid and time to onset of labour. MAIN OUTCOME MEASURES Time from examination to onset of labour (cervix > or =4 cm), within 24 hours and 48 hours. RESULTS The median time interval between examination and spontaneous onset of labour was 8.4 hours for women with 'high' lactate (> or =4.5 mmol/l) and 54 hours for those with 'low' lactate concentrations (<4.5 mmol/l). Among 86 women with high lactate concentrations, 76 (88%) had started labour within 24 hours compared with 20 of 93 (22%) women with low lactate concentrations (OR 27.7, 95% CI 12.2-63.3). After checking for the effect of visible amniotic fluid, the corresponding odds were still substantially increased (OR 13.5, 95% CI 5.3-34.3). CONCLUSIONS High lactate concentration (> or =4.5 mmol/l) in vaginal fluid can be used to predict whether a woman with suspected PROM will commence spontaneous onset of labour within 24 or 48 hours.
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Affiliation(s)
- E Wiberg-Itzel
- Department of Obstetrics and Gynaecology, Söder Hospital, Stockholm, Sweden.
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Ramanah R, Martin A, Riethmuller D, Maillet R, Schaal JP. Intérêt de la mesure des lactates au scalp fœtal au cours du travail. Étude comparative avec le pH au scalp. ACTA ACUST UNITED AC 2005; 33:107-12. [PMID: 15848081 DOI: 10.1016/j.gyobfe.2005.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2004] [Accepted: 01/28/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the validity and the feasibility of fetal scalp lactate sampling during labour in the assessment of non reassuring fetal status. PATIENTS AND METHOD A prospective observational study was conducted on 129 fetal scalp blood samplings. Scalp lactate measurements were compared to scalp pH (gold standard procedure), neonatal cord blood gas (pH and lactates) and Apgar score. Pathological values taken were for scalp lactates>5 mmol/l, scalp pH<7.20, cord arterial pH<7.10, cord arterial lactates>6,35 mmol/l, and Apgar score<7 at one and five minutes. All measurements were performed using the Rapid Lab 860 device from Bayer. RESULTS Scalp lactate correlated significantly with scalp pH (R=-0.54, P=0.001), with umbilical artery pH (R=-0.46, P=0,01), with umbilical artery lactate (P=0.49, P=0.01), but with neither Apgar score at one minute (R=-0.21, ns) nor at 5 minutes (R=-0.11, ns). Scalp lactate at a cut-off value of 5 mmol/l had the same predictive values than scalp pH at 7.20 to predict neonatal acidosis. Sampling failure with scalp lactate was inferior to 1 vs 18% for scalp pH. DISCUSSION AND CONCLUSION The measurement of lactate in fetal blood scalp seems correlated to the fetal scalp pH. It may be an attractive alternative to pH analysis and a useful tool for monitoring fetal asphyxia, especially with the advent of handheld devices requiring small sample volumes.
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Affiliation(s)
- R Ramanah
- Service de gynécologie-obstétrique, CHR Saint-Jacques, avenue du 8-Mai-1945, 25030 Besançon cedex, France
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