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Gebara SA, Melov SJ, Alahakoon TI, Sholler G, Nayyar R. Fetal heart block: Vaginal delivery an option. Aust N Z J Obstet Gynaecol 2023; 63:212-218. [PMID: 35897126 DOI: 10.1111/ajo.13595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/08/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Fetal heart block (FHB) occurs in approximately 1:20 000 births and is associated with significant morbidity and mortality. Vaginal delivery with intrapartum fetal scalp lactate monitoring is offered as an option at our centre for selected cases, in contrast with the published literature advocating caesarean birth. AIMS To review perinatal outcomes at delivery for FHB at a tertiary referral hospital. MATERIALS AND METHODS Ours was a retrospective cohort study from 1 January, 2007 to 30 June, 2020. The infant outcomes are summarised in three delivery groups: vaginal delivery, planned caesarean section (CS) and unplanned CS. RESULTS There were 23 newborns in the study period, with a median gestation at birth of 37.2 weeks and there was one antepartum fetal death in this cohort. Vaginal delivery was planned in 12 women: eight had normal births, three of these women progressed to an intrapartum (unplanned) CS and one woman had a planned CS. All live babies in the vaginal delivery cohort had an Apgar score greater than seven at five minutes. Of the 22 newborns, six required intubation, of which five had been delivered by a planned CS. CONCLUSION Our data suggest that planned vaginal delivery is a safe option for selected women carrying a fetus with FHB. Managing labour with serial fetal scalp lactates, and the involvement of senior clinicians are important factors in achieving a successful outcome.
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Affiliation(s)
- Sarah Asmaa Gebara
- Westmead Institute for Maternal & Fetal Medicine, Department of Women's and Newborn Health, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sarah Jane Melov
- Westmead Institute for Maternal and Fetal Medicine, Department of Women and Newborn, Westmead Hospital, Sydney, New South Wales, Australia
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Thushari Indika Alahakoon
- Westmead Institute for Maternal and Fetal Medicine, Department of Women and Newborn, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gary Sholler
- The Heart Centre for Children, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Roshini Nayyar
- Westmead Institute for Maternal & Fetal Medicine, Department of Women's and Newborn Health, Westmead Hospital, Sydney, New South Wales, Australia
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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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Fung AWS, Mattman A, Wang L, Burton T, Beach LA, Füzéry AK. Intrapartum Fetal Scalp Lactate Testing: Considerations for Implementation and Clinical Decision Making. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1244-1246. [PMID: 34758905 DOI: 10.1016/j.jogc.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Angela W S Fung
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, BC.
| | - Andre Mattman
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - Li Wang
- Department of Pathology and Laboratory Medicine, B.C. Children's Hospital and University of British Columbia, Vancouver, BC
| | - Teralee Burton
- Department of Pathology and Laboratory Medicine, Kelowna General Hospital and University of British Columbia, Kelowna, BC
| | - Lori A Beach
- Department of Pathology and Laboratory Medicine, IWK Health, Halifax and Dalhousie University, NS
| | - A K Füzéry
- Alberta Precision Laboratories and Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB
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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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Dore S, Ehman W. No. 396-Fetal Health Surveillance: Intrapartum Consensus Guideline. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 42:316-348.e9. [PMID: 32178781 DOI: 10.1016/j.jogc.2019.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To present evidence and recommendations regarding use, classification, interpretation, response, and documentation of fetal surveillance in the intrapartum period and to provide information to help minimize the risk of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. INTENDED USERS Members of intrapartum care teams, including but not limited to obstetricians, family physicians, midwives and nurses, and their learners TARGET POPULATION: Intrapartum women OPTIONS: All methods of uterine activity assessment and fetal heart rate surveillance were considered in developing this document. OUTCOMES The impact, benefits, and risks of different methods of surveillance on the diverse maternal-fetal health conditions have been reviewed based on current evidence and expert opinion. No fetal surveillance method will provide 100% detection of fetal compromise; thus, all FHS methods are viewed as screening tests. As the evidence continues to evolve, caregivers from all disciplines are encouraged to attend evidence-based Canadian educational programs every 2 years. EVIDENCE Literature published between January 1976 and February 2019 was reviewed. Medline, the Cochrane Database, and international guidelines were used to search the literature for all studies on intrapartum fetal surveillance. VALIDATION METHODS The principal and contributing authors agreed to the content and recommendations. The Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care. BENEFITS, HARM, AND COSTS Consistent interdisciplinary use of the guideline, appropriate equipment, and trained professional staff enhances safe intrapartum care. Women and their support person(s) should be informed of the benefits and harms of different methods of fetal health surveillance. RECOMMENDATIONS CommunicationSupport During Active LabourPrinciples of Intrapartum Fetal SurveillanceSelecting the Method of Fetal Heart Rate Monitoring: Intermittent Auscultation or Electronic Fetal MonitoringPaper SpeedAdmission AssessmentsEpidural AnalgesiaIntermittent Auscultation in LabourElectronic Fetal Monitoring in LabourClassification of Intrapartum Fetal SurveillanceMaternal Heart RateFetal Health Surveillance Assessment in the Active Second Stage of LabourIntrauterine ResuscitationDigital Fetal Scalp StimulationFetal Scalp Blood SamplingUmbilical Cord Blood GasesDocumentationFetal Surveillance Technology Not RecommendedFetal Health Surveillance Education.
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Dore S, Ehman W. No396 - Surveillance du bien-être fœtal : Directive clinique de consensus des soins intrapartum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:349-384.e10. [DOI: 10.1016/j.jogc.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Romanov AY, Prikhodko AM, Tysyachnyi OV, Baev OR, Yarotskaya EL, Sukhikh GT. Comparison of cord blood lactate measurement by gas analyzer and portable electrochemical devices. J Perinat Med 2020; 48:157-161. [PMID: 31821169 DOI: 10.1515/jpm-2019-0357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Andrey Yurievich Romanov
- Specialist of R&D Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Health of Russian Federation, Ac. Oparina Str. 4, 117997 Moscow, Russian Federation, Tel.: +7 (903) 158-94-00
| | - Andrey Mikhailovich Prikhodko
- Maternity Department, Department Obstetrics and Gynecology, Researcher of the Innovative Technologies Department of Obstetrics Institute, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russian Federation
| | - Oleg Vladimirovich Tysyachnyi
- Maternity Departments, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia, Moscow, Russian Federation
| | - Oleg Radomirovich Baev
- Maternity Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation.,Department of Obstetrics, Gynecology, Perinatology, and Reproductology of I.N. Sechenov First Moscow State Medical University of Ministry of Healthcare of Russian Federation, Moscow, Russian Federation
| | - Ekaterina Lvovna Yarotskaya
- Department for International Cooperation, Research Center of Obstetrics, Gynecology and Perinatology, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Gennady Tikhonovich Sukhikh
- Russian Academy of Sciences, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russian Federation
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Effects of a Bout of Intense Exercise on Some Executive Functions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030898. [PMID: 32024008 PMCID: PMC7036842 DOI: 10.3390/ijerph17030898] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/18/2020] [Accepted: 01/24/2020] [Indexed: 12/22/2022]
Abstract
The present study examined the effects of an exhaustive exercise on executive functions by using the Stroop Color Word Test (SCWT), Trail Making Test (TMT), A and B, and simple Reaction Time (RT). Thirty adults agreed to participate; 15 participants had a mean age of 24.7 years ± 3.2 Standard Deviation (SD, Standard Deviation) (group YOUNG), while the remaining 15 had a mean age of 58.9 years ± 2.6 SD (group OLD). Each subject performed the cognitive tasks at rest and blood lactate was measured (pre); each subject executed the acute exhaustive exercise and, immediately after the conclusion, executed the cognitive tasks and blood lactate was again measured (end). Cognitive tests were repeated and blood lactate measured 15 min after its conclusion of the exhaustive exercise (post). We observed: (1) a significant positive correlation between blood lactate levels and RT levels; (2) a significant negative relationship between levels of blood lactate and the SCWT mean score; (3) no significant correlation between blood lactate levels and TMT scores (time and errors), both A and B; (4) variations in blood lactate levels, due to exhaustive exercise, and parallel deterioration in the execution of RT and SCWT are significantly more pronounced in the group YOUNG than in the group OLD. The present study supports the possibility that high levels of blood lactate induced by an exhaustive exercise could adversely affect the executive functions pertaining to the prefrontal cortex.
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Clinical Performance and Utility of Point-of-Care Lactate Technology in Patient Care Pathways. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/poc.0000000000000185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Iorizzo L, Persson KEM, Kristensen KH, Wiberg N. Reliability of the point-of care analyzer "StatStrip® Xpress™" for measurement of fetal blood lactate. Clin Chim Acta 2019; 495:88-93. [PMID: 30953612 DOI: 10.1016/j.cca.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/04/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Measurement of lactate in fetal blood is used to assess the degree of anaerobic metabolism. The technical difficulties in obtaining enough scalp blood for analysis by a bloodgas-analyzer advocates for the use of a point-of-care device. StatStrip®Xpress™ (SSX) has shown promising properties but needs further evaluation before implementation into fetal surveillance. METHODS Arterial/venous umbilical cord blood from 112 newborns were analyzed simultaneously with SSX and the reference method ABL800™. From 321 fetuses with abnormal heart rate scalp blood was sampled and analyzed repeatedly with SSX. RESULTS ABL800™ -lactate ranged from 1.9-13.3 mmol/L in arterial to 1.5-10.2 mmol/L in venous cord blood with excellent correlation to SSX (R2 = 0.95). SSX-values were lower compared to the reference method ranging from -0.79 mmol/L for low values to -1.68 mmol/L for high values. The mean CV for SSX-values in cord respectively scalp blood was: lactate ≤3 mmol/L 7.1% respectively 8.4%; lactate >3 mmol/L 3.8% respectively 6.8%. Repeated measurements of the same sample with SSX where without significant difference in cord/scalp blood (p = 0.11). CONCLUSION SSX-lactate values were constantly lower but correlated excellent to the reference method. The reproducibility was good for cord and scalp blood. We suggest SSX as an attractive device for measurement of fetal lactate.
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Affiliation(s)
- Linda Iorizzo
- Department of Obstetrics and Gynecology, Skåne University Hospital, Sweden; Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Kristina E M Persson
- Department of Laboratory Medicine, Lund University, Skåne University Hospital, Sweden
| | | | - Nana Wiberg
- Department of Obstetrics and Gynecology, Skåne University Hospital, Sweden; Department of Clinical Sciences, Lund University, Malmö, Sweden.
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