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Mönkkönen A, Rajala K, Backman H, Keski-Nisula L. Umbilical arterial lactate levels after normal vaginal and elective cesarean delivery: The role of a longer active second stage most significant in high levels after vaginal delivery. J Obstet Gynaecol Res 2024; 50:557-565. [PMID: 38168051 DOI: 10.1111/jog.15875] [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: 08/23/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Abstract
AIM To evaluate umbilical arterial lactate concentrations after spontaneous vaginal delivery and after elective Cesarean delivery, and to study the simultaneous effects of maternal and obstetric variables in high lactate levels in vaginally delivered healthy term singletons. METHODS The birth register study included information about the umbilical artery lactate values and clinical perinatal data from 7723 women and their singleton newborns (7301 spontaneous vaginal and 422 elective cesareans) from Kuopio University Hospital, Finland. High lactate levels were evaluated more extensively among healthy term neonates (N = 6541), to evaluate high levels after normal vaginal labors. RESULTS The mean lactate level was significantly lower after elective cesarean compared to vaginal delivery (2.42 [0.94] vs. 3.56 [1.62] mmol/l; p < 0.0001). Consequently, the 90th percentile limit values were 3.60 and 5.80 mmol/L. Among healthy term newborns born vaginally, higher lactate values (≥5.80 mmol/L) were independently associated with a longer duration of the active second stage of labor (ORs 1.91-10.97) and duration of ruptured fetal membranes (ORs 1.36-2.46), higher gestational age at birth (ORs 1.41-1.86), null parity (OR 2.17), maternal infection (OR 1.81) and short maternal stature (OR 1.45). We report 90th/95th limits for umbilical arterial lactate values in relation to the various durations of labors for term newborns who are delivered by the vaginal route. CONCLUSIONS Even though the high umbilical lactate levels may indicate serious birth asphyxia, levels after vaginal birth reflect the physiological stress and subclinical transient asphyxia frequently seen in normal vaginal deliveries.
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Affiliation(s)
- Arttu Mönkkönen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Kontiolahti Health Center, Siun Sote, Kontiolahti, Finland
| | - Katri Rajala
- Department of Clinical Genetics, Kuopio University Hospital, Kuopio, Finland
| | - Heli Backman
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Wellbeing services county of North Savo, Kuopio, Finland
| | - Leea Keski-Nisula
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Wellbeing services county of North Savo, Kuopio, Finland
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Li YH, Lei GY, Guo J, Yi M, Fu YJ, Wang GY. Effect of maternal oxygen supplementation for parturient undergoing elective cesarean section by high-flow nasal oxygen compared with room air on fetal acidemia: study protocol for a randomized controlled trial. Trials 2024; 25:73. [PMID: 38254137 PMCID: PMC10802011 DOI: 10.1186/s13063-024-07927-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Maternal oxygen supplementation is usually used as an intrauterine resuscitation technique to prevent fetal hypoxia and acidemia during delivery. However, there has been a great deal of controversy regarding the effects of prophylactic maternal oxygen during cesarean section, during which the incidence of fetal acidemia seems to be higher compared with that during labor. High-flow nasal oxygen (HFNO) can improve oxygenation better in patients with high-flow oxygen airflow. The purpose of this study is to determine whether maternal oxygen supplementation with HFNO has a positive effect on fetal acidemia during cesarean section through umbilical arterial blood gas analysis. METHOD This prospective, single-center, randomized, double-blinded trial will enroll 120 patients undergoing cesarean section. Participants will be randomly assigned to the HFNO group or air group at a 1:1 ratio. For parturients in the HFNO group, the flow rate is 40L/min, and the oxygen is heated to 37℃ with humidity 100% oxygen concentration through the Optiflow high-flow nasal oxygen system. And for the air group, the flow rate is 2 L/min with an air pattern through the same device. The primary outcome was umbilical artery (UA) lactate. Secondary outcomes include UA pH, PO2, PCO2, BE, the incidence of pH < 7.20 and pH < 7.10, Apgar scores at 1 and 5 min, and neonatal adverse outcomes. DISCUSSION Our study is the first trial investigating whether maternal oxygen supplementation with HFNO can reduce the umbilical artery lactate levels and the incidence of fetal acidemia in cesarean section under combined spinal-epidural anesthesia. TRIAL REGISTRATION ClinicalTrials.gov NCT05921955. Registered on 27 June 2023.
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Affiliation(s)
- Yun-Hui Li
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Gui-Yu Lei
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jun Guo
- Department of Gynecologic and Obstetric, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Meng Yi
- Department of Gynecologic and Obstetric, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yu-Jing Fu
- Department of Gynecologic and Obstetric, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Gu-Yan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Glucose-to-lactate ratio and neurodevelopment in infants with hypoxic-ischemic encephalopathy: an observational study. Eur J Pediatr 2023; 182:837-844. [PMID: 36484862 PMCID: PMC9899169 DOI: 10.1007/s00431-022-04694-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/24/2022] [Accepted: 11/05/2022] [Indexed: 12/13/2022]
Abstract
UNLABELLED We aimed to assess the glucose and lactate kinetics during therapeutic hypothermia (TH) in infants with hypoxic-ischemic encephalopathy and its relationship with longitudinal neurodevelopment. We measured glucose and lactate concentrations before TH and on days 2 and 3 in infants with mild, moderate, and severe hypoxic-ischemic encephalopathy (HIE). Neurodevelopment was assessed at 2 years. Participants were grouped according to the neurodevelopmental outcome into favorable (FO) or unfavorable (UFO). Eighty-eight infants were evaluated at follow-up, 34 for the FO and 54 for the UFO group. Severe hypo- (< 2.6 mmol/L) and hyperglycemia (> 10 mmol/L) occurred in 18% and 36% from the FO and UFO groups, respectively. Glucose-to-lactate ratio on day 1 was the strongest predictor of unfavorable metabolic outcome (OR 3.27 [Formula: see text] 1.81, p = 0.032) when adjusted for other clinical and metabolic variables, including Sarnat score. CONCLUSION Glucose-to-lactate ratio on day 1 may represent a new risk marker for infants with HIE undergoing TH. WHAT IS KNOWN • Glucose and lactate are key metabolic fuels during neonatal hypoglycemia. This suggests that their concentrations may influence the neurodevelopmental outcome of neonates experiencing hypoxic-hischemic encephalopathy (HIE). WHAT IS NEW • We describe the relative availbility of glucose and lactate before and during theraputic hypothermia in neonates with HIE.
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Wang Y, Chen J, Wang X, Guo C, Peng X, Liu Y, Li T, Du J. Novel investigations in retinoic-acid-induced cleft palate about the gut microbiome of pregnant mice. Front Cell Infect Microbiol 2022; 12:1042779. [PMID: 36590585 PMCID: PMC9798234 DOI: 10.3389/fcimb.2022.1042779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Cleft palate (CP) is one of the most common congenital birth defects in the craniofacial region, retinoic acid (RA) gavage is the most common method for inducing cleft palate model. Although several mechanisms have been proposed to illuminate RA-induced cleft palate during embryonic development, these findings are far from enough. Many efforts remain to be devoted to studying the etiology and pathogenesis of cleft palate. Recent research is gradually shifting the focus to the effect of retinoic acid on gut microbiota. However, few reports focus on the relationship between the occurrence of CP in embryos and gut microbiota. Methods In our research, we used RA to induce cleft palate model for E10.5 the feces of 5 RA-treated pregnant mice and 5 control pregnant mice were respectively metagenomics analysis. Results Compared with the control group, Lactobacillus in the gut microbiome the RA group was significantly increased. GO, KEGG and CAZy analysis of differentially unigenes demonstrated the most abundant metabolic pathway in different groups, lipopolysaccharide biosynthesis, and histidine metabolism. Discussion Our findings indicated that changes in the maternal gut microbiome palatal development, which might be related to changes in Lactobacillus and These results provide a new direction in the pathogenesis of CP induced by RA.
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Affiliation(s)
- Yijia Wang
- Laboratory of Orofacial Development, Capital Medical University School of Stomatology, Beijing, China,Laboratory of Molecular Signaling and Stem Cells Therapy, Capital Medical University School of Stomatology, Beijing, China,Molecular Laboratory for Gene Therapy and Tooth Regeneration, Capital Medical University School of Stomatology, Beijing, China,Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
| | - Jing Chen
- Laboratory of Orofacial Development, Capital Medical University School of Stomatology, Beijing, China,Laboratory of Molecular Signaling and Stem Cells Therapy, Capital Medical University School of Stomatology, Beijing, China,Molecular Laboratory for Gene Therapy and Tooth Regeneration, Capital Medical University School of Stomatology, Beijing, China,Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
| | - Xiaotong Wang
- Laboratory of Orofacial Development, Capital Medical University School of Stomatology, Beijing, China,Laboratory of Molecular Signaling and Stem Cells Therapy, Capital Medical University School of Stomatology, Beijing, China,Molecular Laboratory for Gene Therapy and Tooth Regeneration, Capital Medical University School of Stomatology, Beijing, China,Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
| | - Cui Guo
- Department of Geriatric Dentistry, Capital Medical University School of Stomatology, Beijing, China
| | - Xia Peng
- Laboratory of Orofacial Development, Capital Medical University School of Stomatology, Beijing, China,Laboratory of Molecular Signaling and Stem Cells Therapy, Capital Medical University School of Stomatology, Beijing, China,Molecular Laboratory for Gene Therapy and Tooth Regeneration, Capital Medical University School of Stomatology, Beijing, China,Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
| | - Ying Liu
- Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China,Laboratory of Oral Microbiology, Capital Medical University School of Stomatology, Beijing, China
| | - Tianli Li
- Laboratory of Orofacial Development, Capital Medical University School of Stomatology, Beijing, China,Laboratory of Molecular Signaling and Stem Cells Therapy, Capital Medical University School of Stomatology, Beijing, China,Molecular Laboratory for Gene Therapy and Tooth Regeneration, Capital Medical University School of Stomatology, Beijing, China,Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
| | - Juan Du
- Laboratory of Orofacial Development, Capital Medical University School of Stomatology, Beijing, China,Laboratory of Molecular Signaling and Stem Cells Therapy, Capital Medical University School of Stomatology, Beijing, China,Molecular Laboratory for Gene Therapy and Tooth Regeneration, Capital Medical University School of Stomatology, Beijing, China,Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China,Department of Geriatric Dentistry, Capital Medical University School of Stomatology, Beijing, China,*Correspondence: Juan Du,
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Kumar N, Yadav A. Umbilical cord arterial blood lactate dehydrogenase and pH as predictors of perinatal outcome in high-risk term pregnancies: A cohort study. JOURNAL OF MOTHER AND CHILD 2022; 26:27-34. [PMID: 35853688 PMCID: PMC10032318 DOI: 10.34763/jmotherandchild.20222601.d-22-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/29/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND Birth asphyxia is a common cause of perinatal morbidity, mortality. OBJECTIVE To compare the efficacy of umbilical cord arterial blood lactate dehydrogenase (LDH) and pH as predictors of neonatal outcome in high-risk term pregnancies using receiver operating characteristic (ROC) curves. MATERIAL AND METHODS Present retrospective cohort study was conducted in the rural tertiary centre of Northern India over two years (January 2017-December 2018). Neonates delivered to 300 term (≥37 - ≤42 weeks) high-risk antenatal women were enrolled after fulfilling inclusion criteria. Immediately after delivery of a newborn by any mode, the segment of the umbilical cord (10 cm) was double clamped, cut, and arterial blood samples were taken for LDH and pH and were compared with neonatal outcome. Statistical analysis was done using SPSS 22.0 software. RESULTS For all 300 neonates mean ± SD values of cord blood LDH and pH were 545.19 ± 391.93 U/L and 7.13 ± 0.15, respectively. High cord blood lactate and low pH values were significantly associated with adverse neonatal outcomes including neonatal resuscitation, NICU admission, complications and early neonatal deaths (p=0.000). The sensitivity, specificity and negative predictive value of cord blood LDH in the prediction of neonatal death was 100.00%, 53.17%, 100%, and pH was 93.75%, 53.17%, 99.34%, respectively. CONCLUSION Cord blood lactate and pH help in the early prediction of neonatal outcomes, but cord blood lactate is a better predictor.
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Affiliation(s)
- Naina Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Ashu Yadav
- Department of Obstetrics and Gynecology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
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