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Determination of Foetal Scalp Blood Sampling pH as an Indicator of Loss of Foetal Well-Being in Women Undergoing Caesarean Section. Healthcare (Basel) 2023; 11:healthcare11050725. [PMID: 36900730 PMCID: PMC10001157 DOI: 10.3390/healthcare11050725] [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: 01/19/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Asphyxia during birth is one of the three leading causes of neonatal morbidity and mortality among newborns carried to term. The objective of this study was to evaluate the measurement of the foetal scalp blood pH as a measure of foetal status, evaluating: cord gases, meconium-stained fluid, APGAR score or the need for neonatal resuscitation in pregnant women undergoing caesarean sections. A cross-sectional study was carried out over a period of 5 years (2017-2021) at the Hospital de Poniente (southern Spain). A total of 127 pregnant women participated from whom a foetal scalp blood pH sample was taken and used to indicate the need for an urgent caesarean section. The results showed a correlation between the pH of the scalp blood and the pH of the umbilical cord artery, umbilical cord vein (Rho of Spearman arterial pH: 0.64, p < 0.001; Rho of Spearman venous pH: 0.58, p < 0.001) and the APGAR test one minute after delivery (Spearman's Rho coefficient of 0.33, p < 0.01). These results suggest that the foetal scalp pH should not be considered a foolproof method to indicate an urgent caesarean section. Foetal scalp pH sampling can be used as a complementary test, in conjunction with cardiotocography, to indicate whether an emergency caesarean section is necessary due to loss of foetal well-being.
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Bohiltea RE, Mihai BM, Ducu I, Cioca AM, Bohiltea AT, Iordache AM, Iordache SM, Grigorescu CEA, Marinescu S. Current Innovative Methods of Fetal pH Monitoring-A Brief Review. Diagnostics (Basel) 2022; 12:2675. [PMID: 36359522 PMCID: PMC9689968 DOI: 10.3390/diagnostics12112675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 09/08/2024] Open
Abstract
In this study, we explore the "why?", and "how?", monitoring the pH of the fetal scalp is used, and show its limitations. In addition, we review the development of new devices based on the modern physics and nanomaterials serving this topic. Most of the works we found in our search have focused on improving the prognostic of fetal heart rate monitoring, because it is the "golden standard" in determining fetal distress. Although the best-known screening method, it can only provide limited information about the actual status of the fetus. The best predictive assessment, with the highest reproducibility, states that a normal fetal heart rate is indicative of a healthy baby. However, its excellent sensitivity is much reduced when identifying the actual "distress". This is when second-line monitoring methods come into play to guide the diagnostics and direct the obstetrician towards an action plan. Although a historic method, fetal scalp pH sampling is still under review as to its efficiency and place in the current obstetrics. Continuous surveillance of the fetal parameters is important, especially for the fetuses undergoing intrauterine growth restricted (IUGR). Since fetal scalp blood sampling is still under research and is a randomized controlled trial, which compares the relevance of pH and lactates to the obstetrical situation, the maternal-fetal medicine could greatly benefit from the introduction of engineered nanomedicines to the field.
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Affiliation(s)
- Roxana-Elena Bohiltea
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11-13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania
| | - Bianca Margareta Mihai
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11-13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania
| | - Ioniță Ducu
- Memorial Life Hospital, Grivitei Route, No. 365, 010719 Bucharest, Romania
| | - Ana-Maria Cioca
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania
| | | | - Ana-Maria Iordache
- Optospintronics Department, National Institute for Research and Development in Optoelectronics-INOE 2000, 409 Atomistilor, 077125 Magurele, Romania
| | - Stefan-Marian Iordache
- Optospintronics Department, National Institute for Research and Development in Optoelectronics-INOE 2000, 409 Atomistilor, 077125 Magurele, Romania
| | - Cristiana Eugenia Ana Grigorescu
- Optospintronics Department, National Institute for Research and Development in Optoelectronics-INOE 2000, 409 Atomistilor, 077125 Magurele, Romania
| | - Silviu Marinescu
- Department 11-Plastic and Reconstructive Surgery, Pediatric Surgery, University of Medicine and Pharmacy “Carol Davila”, Eroii Sanitari Bvd., No. 8, Sector 5, 050471 Bucharest, Romania
- Discipline of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital “Bagdasar-Arseni”, Berceni Street, No. 12, Sector 4, 041915 Bucharest, Romania
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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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Kapaya H, Jacques R, Almond T, Rosser MH, Anumba D. Is short-term-variation of fetal-heart-rate a better predictor of fetal acidaemia in labour? A feasibility study. PLoS One 2020; 15:e0236982. [PMID: 32745099 PMCID: PMC7398510 DOI: 10.1371/journal.pone.0236982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/18/2020] [Indexed: 11/22/2022] Open
Abstract
Background Continuous intrapartum fetal monitoring is challenging and its clinical benefits are debated. The project evaluated whether short-term-variation (STV) and other computerised fetal heart rate (FHR) parameters (baseline FHR, long-term-variation, accelerations and decelerations) predicted acidaemia at birth. The aims of the study were to assess the changes in FHR pattern during labour and determine the feasibility of undertaking a definitive trial by reporting the practicalities of using the monitoring device, participant recruitment, data collection and staff training. Methods 200 high-risk women carrying a term singleton, non-anomalous fetus, requiring continuous FHR monitoring in labour were consented to participate from the Jessop Wing maternity unit, Sheffield, UK. The trans-abdominal fetal ECG monitor was placed as per clinical protocol. During the monitoring session, clinicians were blinded to the computerised FHR parameters. We analysed the last hour of the FHR and its ability to predict umbilical arterial blood pH <7.20 using receiver operator characteristics (ROC) curves. Results Of 200 women, 137 cases were excluded as either the monitor did not work from the onset of labour (n = 30), clinical staff did not return or used the monitor on another patient (n = 37), umbilical cord blood not obtained (n = 25), FHR data not recorded within an hour of birth (n = 34) and other reasons (n = 11). In 63 cases included in the final analysis, the computer-derived FHR parameters did not show significant correlation with umbilical artery cord pH <7.20. Labour was associated with a significant increase in short and long term variation of FHR and number of deceleration (P<0.001). However, baseline FHR decreased significantly before delivery (P<0.001). Conclusions The project encountered a number of challenges, with learning points crucial to informing the design of a large study to evaluate the potential place of intrapartum computerised FHR parameters, using abdominal fetal ECG monitor before its clinical utility and more widespread adoption can be ascertained.
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Affiliation(s)
- Habiba Kapaya
- Sheffield Teaching Hospitals, NHS Foundation Trust, Tree Root Walk, Sheffield, United Kingdom
- * E-mail:
| | - Richard Jacques
- Medical Statistics Group, School of Health and Related Research (ScHARR), University of Sheffield, United Kingdom
| | - Thomas Almond
- Obstetrics and Gynaecology, Sheffield Teaching Hospitals, NHS Foundation Trust, Tree Root Walk, Sheffield, United Kingdom
| | - Miss Hilary Rosser
- Obstetrics and Gynaecology, Sheffield Teaching Hospitals, NHS Foundation Trust, Tree Root Walk, Sheffield, United Kingdom
| | - Dilly Anumba
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Tree Root Walk, Sheffield, United Kingdom
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Shakouri F, Iorizzo L, Edwards HMK, Vinter CA, Kristensen K, Isberg PE, Wiberg N. Effectiveness of fetal scalp stimulation test in assessing fetal wellbeing during labor, a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:347. [PMID: 32503518 PMCID: PMC7275571 DOI: 10.1186/s12884-020-03030-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/22/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Farzaneh Shakouri
- Department of Gynecology and Obstetrics, Sjælland University Hospital, Roskilde, Denmark
| | - Linda Iorizzo
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Gynecology and Obstetrics, Helsingborg Hospital, Helsingborg, Sweden.
| | - Hellen Mc Kinnon Edwards
- Department of Gynecology and Obstetrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christina Anne Vinter
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karl Kristensen
- Department of Clinical Sciences Lund, Gynecology and Obstetrics, Lund University, Faculty of Medicine, Lund, Sweden
| | | | - Nana Wiberg
- Department of Clinical Sciences Lund, Gynecology and Obstetrics, Lund University, Faculty of Medicine, Lund, Sweden
- Department of Gynecology and Obstetrics, Skåne University Hospital, Ystad, Sweden
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Stål I, Wennerholm UB, Nordstrom L, Ladfors L, Wiberg-Itzel E. Fetal scalp blood sampling during second stage of labor - analyzing lactate or pH? A secondary analysis of a randomized controlled trial. J Matern Fetal Neonatal Med 2020; 35:1100-1107. [PMID: 32233704 DOI: 10.1080/14767058.2020.1743656] [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] [Indexed: 10/24/2022]
Abstract
Background: Cardiotocography (CTG) is a widely used method for assessing fetal wellbeing during labor. It is well-known that CTG has high sensitivity but low specificity. To avoid unnecessary operative interventions, adjunctive methods such as fetal blood sampling (FBS) are used. Few studies have looked into whether FBS can be used during second stage of labor, and in that case, which of the methods (lactate or pH) are preferred.Objective: To evaluate clinical effectiveness of measuring lactate versus pH in preventing birth acidemia when FBS was performed during second stage of labor.Methods: Secondary analysis of a randomized controlled trial . Thousand three hundred and thirty-eight women with a singleton pregnancy, cephalic presentation, gestational age ≥34 weeks, and indication for FBS during second stage of labor were included.Main outcome measures: Metabolic acidemia (pH <7.05 and base deficit >12 mmol/l) or pH < 7.00 in cord arterial blood at birth.Secondary outcomes: A composite outcome (metabolic acidemia, pH <7 or Apgar score <4), and rates of operative deliveries.Results: Metabolic acidemia occurred in 4.1% in the lactate versus 5.1% in the pH group (relative risk (RR): 0.80; 95% confidence interval (CI): 0.48-1.35) and pH <7 in 1.4% versus 2.8% (RR: 0.51, 95% CI: 0.23-1.13). Composite outcome was found in 3.8 versus 4.9%, respectively (RR: 0.76; 95% CI: 0.46-1.26). No difference in total operative interventions was found. More cesarean deliveries were performed in the lactate group (16.5 vs. 12.4%; RR: 1.33; 95% CI: 1.02-1.74).Conclusion: When analyzing lactate or pH in fetal scalp blood during second stage of labor neonatal outcomes were comparable. The frequency of total operative interventions was similar but more cesarean deliveries were performed in the lactate group.
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Affiliation(s)
- Ingrid Stål
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital East, Gothenburg, Sweden
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital East, Gothenburg, Sweden
| | - Lennart Nordstrom
- Department of Women and Children's Health, Karolinska Institute, Stockholm, Sweden.,Department of Pregnancy and Delivery, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Ladfors
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital East, Gothenburg, Sweden
| | - Eva Wiberg-Itzel
- Department of Clinical Science and Education, Section of Obstetrics and Gynecology, Karolinska Institute, Womens clinic Sodersjukhuset, Stockholm, Sweden
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Stirk L, Kornelsen J. No 379 - Assistance et ressources en matière de prestation de soins de maternité optimaux. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:697-707.e5. [DOI: 10.1016/j.jogc.2019.02.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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No. 379-Attendance at and Resources for Delivery of Optimal Maternity Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:688-696.e4. [DOI: 10.1016/j.jogc.2018.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Murray DM. Biomarkers in neonatal hypoxic-ischemic encephalopathy-Review of the literature to date and future directions for research. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:281-293. [PMID: 31324315 DOI: 10.1016/b978-0-444-64029-1.00013-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The widespread introduction of therapeutic hypothermia as a standard of care in hypoxic-ischemic encephalopathy (HIE) has brought increasing pressure on clinicians to make an early and accurate assessment of the degree of hypoxic injury (HI) that has occurred and the severity of the encephalopathy that will ensue. No single blood-based marker is currently robust enough to detect significant HI or predict outcome. However, research in the field has been active in the last 10 years and we know that HIE is associated with predictable alterations in the expression of a number of inflammatory proteins, neuron-specific proteins, metabolite pathways, and microRNA. These alterations evolve quickly over the first hours and days of life. Predictive power varies depending on the timing of measurement of the biomarker, the sample type, and the case mix of the cohort examined. Combining clinical data with biochemical measurements is currently the most likely path toward improved detection and prediction of outcome in neonatal HIE.
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Affiliation(s)
- Deirdre M Murray
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
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Wang M, Chua SC, Bouhadir L, Treadwell EL, Gibbs E, McGee TM. Point-of-care measurement of fetal blood lactate - Time to trust a new device. Aust N Z J Obstet Gynaecol 2017; 58:72-78. [DOI: 10.1111/ajo.12671] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mandy Wang
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
| | - Seng C. Chua
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
| | - Lilain Bouhadir
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
| | - Erin L. Treadwell
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
| | - Emma Gibbs
- NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - Therese M. McGee
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
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Pascual Mancho J, Marti Gamboa S, Redrado Gimenez O, Crespo Esteras R, Rodriguez Solanilla B, Castan Mateo S. Diagnostic accuracy of fetal scalp lactate for intrapartum acidosis compared with scalp pH. J Perinat Med 2017; 45:315-320. [PMID: 27718493 DOI: 10.1515/jpm-2016-0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 09/01/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of fetal scalp lactate sampling (FSLS) and to establish an optimal cut-off value for intrapartum acidosis compared with fetal scalp pH. METHODS A 20-month retrospective cohort study was conducted of all neonates delivered in our institution for whom fetal scalp blood sampling (FSBS) was performed, matching their intrapartum gasometry to their cord gasometry at delivery (n=243). The time taken from the performance of scalp blood sampling to arterial umbilical cord gas acquisition was 45 min at most. Five arterial cord gasometry patterns were set for assessing the predictive ability of both techniques. Subsequent obstetric management for a pathological value was analysed considering the use of both techniques. RESULTS The optimal cut-off value for FSLS was 4.8 mmol/L: this value has 100% sensitivity and 63% specificity for umbilical arterial cord gas pH≤7.0 and base deficit (BD)≥12 detection, and 100% sensitivity and 64% specificity for umbilical arterial cord gas pH≤7.10 and BD≥12 detection, with a false negative rate of <1.3%, improving fetal scalp pH performance. FSLS showed the best area under the curve (AUC) of 0.86 and 0.84 for both arterial cord gasometry patterns, respectively. Expedite birth following lactate criteria would have been the same as following pH criteria (92 obstetric interventions) with no cases of missed metabolic acidosis. In the cohort, 19.8% of cases were discordant, but no cases of metabolic acidosis were in this group. CONCLUSIONS FSLS improves the detection of metabolic acidosis via fetal scalp pH with an optimal cut-off value of 4.8 mmol/L. FSLS can be used without increasing obstetrical interventions or missing metabolic acidosis.
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Affiliation(s)
- Jara Pascual Mancho
- Departamento de Obstetricia, Hospital Universitario Miguel Servet, P° Isabel la Católica, Zaragoza 50009
| | - Sabina Marti Gamboa
- Departamento de Obstetricia, Hospital Universitario Miguel Servet, P° Isabel la Católica, Zaragoza 50009
| | - Olga Redrado Gimenez
- Departamento de Obstetricia, Hospital Universitario Miguel Servet, P° Isabel la Católica, Zaragoza 50009
| | - Raquel Crespo Esteras
- Departamento de Obstetricia, Hospital Universitario Miguel Servet, P° Isabel la Católica, Zaragoza 50009
| | - Belen Rodriguez Solanilla
- Departamento de Obstetricia, Hospital Universitario Miguel Servet, P° Isabel la Católica, Zaragoza 50009
| | - Sergio Castan Mateo
- Departamento de Obstetricia, Hospital Universitario Miguel Servet, P° Isabel la Católica, Zaragoza 50009
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Visser GH, Ayres-de-Campos D. FIGO consensus guidelines on intrapartum fetal monitoring: Adjunctive technologies. Int J Gynaecol Obstet 2016; 131:25-9. [PMID: 26433402 DOI: 10.1016/j.ijgo.2015.06.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Gerard H Visser
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands
| | - Diogo Ayres-de-Campos
- Medical School, Institute of Biomedical Engineering, S. Joao Hospital, University of Porto, Portugal
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13
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Lowe B, Beckmann M. Involving the consultant before fetal blood sampling. Aust N Z J Obstet Gynaecol 2016; 56:387-90. [DOI: 10.1111/ajo.12480] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/23/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Belinda Lowe
- Department of Obstetrics and Gynaecology; Mater Health Services; South Brisbane Queensland Australia
| | - Michael Beckmann
- Department of Obstetrics and Gynaecology; Mater Health Services; South Brisbane Queensland Australia
- Mater Research; The University of Queensland; South Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
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14
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Torres-Cuevas I, Cernada M, Nuñez A, Escobar J, Kuligowski J, Chafer-Pericas C, Vento M. Oxygen Supplementation to Stabilize Preterm Infants in the Fetal to Neonatal Transition: No Satisfactory Answer. Front Pediatr 2016; 4:29. [PMID: 27148504 PMCID: PMC4835680 DOI: 10.3389/fped.2016.00029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/17/2016] [Indexed: 12/04/2022] Open
Abstract
Fetal life elapses in a relatively low oxygen environment. Immediately after birth with the initiation of breathing, the lung expands and oxygen availability to tissue rises by twofold, generating a physiologic oxidative stress. However, both lung anatomy and function and the antioxidant defense system do not mature until late in gestation, and therefore, very preterm infants often need respiratory support and oxygen supplementation in the delivery room to achieve postnatal stabilization. Notably, interventions in the first minutes of life can have long-lasting consequences. Recent trials have aimed to assess what initial inspiratory fraction of oxygen and what oxygen targets during this transitional period are best for extremely preterm infants based on the available nomogram. However, oxygen saturation nomogram informs only of term and late preterm infants but not on extremely preterm infants. Therefore, the solution to this conundrum may still have to wait before a satisfactory answer is available.
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Affiliation(s)
| | - Maria Cernada
- Neonatal Research Group, Health Research Institute La Fe , Valencia , Spain
| | - Antonio Nuñez
- Neonatal Research Group, Health Research Institute La Fe , Valencia , Spain
| | - Javier Escobar
- Neonatal Research Group, Health Research Institute La Fe , Valencia , Spain
| | - Julia Kuligowski
- Neonatal Research Group, Health Research Institute La Fe , Valencia , Spain
| | | | - Maximo Vento
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain; Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain; Spanish Maternal, Infant and Developmental Network (Red SAMID), Spanish Ministry of Economy and Competitiveness, Madrid, Spain
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East CE, Leader LR, Sheehan P, Henshall NE, Colditz PB, Lau R. Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace. Cochrane Database Syst Rev 2015; 2015:CD006174. [PMID: 25929461 PMCID: PMC10823414 DOI: 10.1002/14651858.cd006174.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Fetal scalp blood sampling for lactate estimation may be considered following identification of an abnormal or non-reassuring fetal heart rate pattern. The smaller volume of blood required for this test, compared with the more traditional pH estimation, may improve sampling rates. The appropriate use of this practice mandates systematic review of its safety and clinical effectiveness prior to widespread introduction. OBJECTIVES To evaluate the effectiveness and risks of fetal scalp lactate sampling in the assessment of fetal well-being during labour, compared with no testing or alternative testing. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2015). SELECTION CRITERIA All published and unpublished randomised and quasi-randomised trials that compared fetal scalp lactate testing with no testing or alternative testing to evaluate fetal status in the presence of a non-reassuring cardiotocograph during labour. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures of the Cochrane Pregnancy and Childbirth Group. Two review authors independently assessed the studies. MAIN RESULTS The search identified two completed randomised controlled trials (RCTs) and two ongoing trials. The two published RCTs considered outcomes for 3348 mother-baby pairs allocated to either lactate or pH estimation of fetal blood samples when clinically indicated in labour. Overall, the published RCTs were of low or unclear risk of bias. There was a high risk of performance bias, because it would not have been feasible to blind clinicians or participants.No statistically significant between-group differences were found for neonatal encephalopathy (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.32 to 3.09, one study, 2992 infants) or death. No studies reported neonatal seizures. We had planned to report death with other morbidities, for example, neonatal encephalopathy; however, the data were not available in a format suitable for this, therefore death due to congenital abnormality was considered alone. The three reported neonatal deaths occurred in babies with diaphragmatic hernias (n = 2) or congenital cardiac fibrosis (n = 1). All three babies had been randomised to the pH group and were not acidaemic at birth.There were no statistically significant differences for any of the pre-specified secondary fetal/neonatal/infant outcomes for which data were available. This included low Apgar score at five minutes (RR 1.13, 95% CI 0.76 to 1.68, two studies, 3319 infants) and admission to neonatal intensive care units (RR 1.02, 95% CI 0.83 to 1.25, one study, 2992 infants), or metabolic acidaemia (RR 0.91, 95% CI 0.60 to 1.36, one study, 2675 infants) considered within the studies, either overall or where data were available for those where fetal blood sampling had occurred within 60 minutes of delivery.Similar proportions of fetuses underwent additional tests to further evaluate well-being during labour, including scalp pH if in the lactate group or scalp lactate if in the pH group (RR 0.22, 95% CI 0.04 to 1.30, two studies, 3333 infants;Tau² 1.00, I² = 58%). Fetal blood sampling attempts for lactate and pH estimation were successful in 98.7% and 79.4% of procedures respectively in the one study that reported this outcome.There were no significant between-group differences in mode of birth or operative birth for non-reassuring fetal status, either for all women, or within the group where the fetal blood sample had been taken within 60 minutes of delivery (for example, caesarean section for all enrolled, RR 1.09, 95% CI 0.97 to 1.22, two studies, 3319 women; operative delivery for non-reassuring fetal status for all enrolled RR 1.02, 95% CI 0.93 to 1.11, one study, 2992 women).Neither study reported on adverse effects of fetal scalp lacerations or maternal anxiety. AUTHORS' CONCLUSIONS When further testing to assess fetal well-being in labour is indicated, fetal scalp blood lactate estimation is more likely to be successfully undertaken than pH estimation. Further studies may consider subgroup analysis by gestational age, the stage of labour and sampling within a prolonged second stage of labour. Additionally, we await the findings from the ongoing studies that compare allocation to no fetal blood sample with sampling for lactate and address longer-term neonatal outcomes, maternal satisfaction with intrapartum fetal monitoring and an economic analysis.
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Affiliation(s)
- Christine E East
- Monash University/Monash HealthSchool of Nursing and Midwifery/Maternity Services246 Clayton RoadClaytonVictoriaAustralia3168
| | - Leo R Leader
- University of New South WalesWomen's and Children's HealthRoyal Hospital for WomenBarker StreetRandwickNSWAustralia2031
| | - Penelope Sheehan
- University of MelbourneDepartment of Obstetrics and GynaecologyPregnancy Research Centre, 7th Floor, Royal Women's Hospital20 Flemington Road, ParkvilleMelbourneVictoriaAustralia3052
| | - Naomi E Henshall
- Royal Hospital for WomenDelivery SuiteRandwickNew South WalesAustralia
| | - Paul B Colditz
- The University of Queensland, Royal Brisbane & Women's HospitalPerinatal Research CentreButterfield StreetHerstonQueenslandAustralia4029
| | - Rosalind Lau
- Monash UniversitySchool of Nursing and MidwiferyWellington RoadClaytonVictoriaAustralia3800
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Chandraharan E, Wiberg N. Fetal scalp blood sampling during labor: an appraisal of the physiological basis and scientific evidence. Acta Obstet Gynecol Scand 2014; 93:544-7. [DOI: 10.1111/aogs.12416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/01/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Nana Wiberg
- Department of Obstetrics and Gynecology; Herlev Hospital; Copenhagen Denmark
- Faculty of Medicine; Lund University; Lund Sweden
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