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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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Gyllencreutz E, Varli IH, Lindqvist PG, Holzmann M. Variable deceleration features and intrapartum fetal acidemia - The role of deceleration area. Eur J Obstet Gynecol Reprod Biol 2021; 267:192-197. [PMID: 34826666 DOI: 10.1016/j.ejogrb.2021.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In recent years deceleration area has received increasing attention as a potential predictor of intrapartum fetal hypoxia. In several studies, the area has been manually esteemed as triangular in shape, which might introduce bias. In addition, the commonly used outcome acidemia in umbilical artery is affected by mode of delivery. We wanted to investigate the association between the variable deceleration features area, duration, depth and cumulative deceleration area (30 and 60 min) and intrapartum fetal acidemia measured as lactate concentration at fetal scalp blood sampling (FBS) in immediate connection to the decelerations. STUDY DESIGN In the source population of 1070 labors at Karolinska University Hospital, Sweden, with FBS performed on indication, we found 507 fetuses with predominantly variable decelerations as the indication for FBS. We examined the last 60- and 30-minutes of fetal monitoring preceding the FBS with focus on deceleration area, duration and depth. The contours of the decelerations were outlined manually but the area was calculated with a computer software program. We assessed area, duration and depth both as mean values per deceleration and as cumulative values during the time period of interest. We analyzed Pearson correlations and area under receiver operating characteristics curves (AUC). We also performed an adjusted analysis, with baseline frequency, variability, and accelerations as covariates. RESULTS Deceleration area and duration were the best predictors of intrapartum fetal acidemia (fetal lactate concentration >4.8 mmol/L measured with Lactate Pro™) with AUCs of 0.671 (0.682) and 0.678 (0.683) for cumulative measures during 30 (60) minutes prior to FBS, compared to deceleration depth with AUC of 0.632 (0.631). Corresponding Pearson correlations in 30-min (60-min) groups were 0.329 (0.335) and 0.358 (0.354) for deceleration area and duration and 0.212 (0.204) for deceleration depth. Using 250 beats cumulative cut-off for deceleration area during last 30 min, 71% vs. 43% were acidemic and non-acidemic, odds ratio = 3.2 (95% CI 1.7-6.1). CONCLUSIONS Deceleration area and duration were better predictors of intrapartum fetal acidemia than deceleration depth. Cumulative deceleration area >250 beats during 30 min was associated with three-fold higher odds of intrapartum acidemia compared to <250 beats.
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Affiliation(s)
- Erika Gyllencreutz
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology, Östersund Hospital, Region Jämtland Härjedalen, Sweden
| | - Ingela Hulthén Varli
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Medical Unit Pregnancy and Childbirth, Karolinska University Hospital, Stockholm, Sweden
| | - Pelle G Lindqvist
- Department of Clinical Sciences and Education, Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Malin Holzmann
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Medical Unit Pregnancy and Childbirth, Karolinska University Hospital, Stockholm, Sweden.
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Musaba MW, Ndeezi G, Barageine JK, Weeks AD, Wandabwa JN, Mukunya D, Waako P, Odongkara B, Arach A, Tulya-Muhika Mugabe K, Kasede Napyo A, Nankabirwa V, Tumwine JK. Incidence and determinants of perinatal mortality among women with obstructed labour in eastern Uganda: a prospective cohort study. Matern Health Neonatol Perinatol 2021; 7:13. [PMID: 34266492 PMCID: PMC8281707 DOI: 10.1186/s40748-021-00133-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/03/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In Uganda, the incidence and determinants of perinatal death in obstructed labour are not well documented. We determined the incidence and determinants of perinatal mortality among women with obstructed labour in Eastern Uganda. METHODS Between July 2018 and September 2019, 584 with obstructed labour were recruited and followed up to the 7th day postnatal. Information on maternal characteristics, obstetric factors and laboratory parameters was collected. Each patient received the standard perioperative care. We used a generalized linear model for the Poisson family, with a log link and robust variance estimation to determine the association between the exposure variables and perinatal death. RESULTS Of the 623 women diagnosed with obstructed labour, 584 met the eligibility criteria. There were 24 fresh still births (FSB) and 32 early neonatal deaths (ENND) giving an FSB rate of 43.8 (95% CI 28.3-64.4) deaths per 1000 total births; early neonatal death rate of 58.4 (95% CI 40.3-81.4) deaths per 1000 and an overall perinatal mortality rate of 102.2 (95% CI 79.4-130.6) deaths in the first 7 days of life. A mother being referred in active labour adjusted risk ratio of 2.84 (95% CI: 1.35-5.96) and having high blood lactate levels at recruitment adjusted risk ratio 2.71 (95% CI: 1.26-4.24) were the determinants of perinatal deaths. CONCLUSIONS The incidence of perinatal death was four times the regional and national average. Babies to women referred in active labour and those with high maternal blood lactate were more likely to die.
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Affiliation(s)
- Milton W Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda.
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda.
- 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
| | - Justus K Barageine
- Department of Obstetrics & Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew D Weeks
- Sanyu Research Unit, University of Liverpool/Liverpool Women's Hospital, Liverpool, UK
| | - Julius N Wandabwa
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - David Mukunya
- Department of Public and Community Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Paul Waako
- Department of Pharmacology and Therapeutics, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Beatrice Odongkara
- Department of Paediatrics and Child Health, Gulu University, Gulu, Uganda
| | - Agnes Arach
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | | | - Agnes Kasede Napyo
- Department of Public and Community Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Centre for Intervention Science and Maternal Child health (CISMAC), Center for International Health, University of Bergen, Bergen, Norway
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Holzmann M, Nordström L, Steer P. Inconsistency between lactate meters in the assessment of fetal metabolic acidemia. Acta Obstet Gynecol Scand 2021; 100:815-817. [PMID: 33870498 DOI: 10.1111/aogs.14140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Malin Holzmann
- Medical Unit of Pregnancy and Delivery Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Nordström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Philip Steer
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, Imperial College London, London, UK
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Lu K, Holzmann M, Abtahi F, Lindecrantz K, Lindqvist PG, Nordstrom L. Fetal heart rate short term variation during labor in relation to scalp blood lactate concentration. Acta Obstet Gynecol Scand 2018; 97:1274-1280. [PMID: 29799630 DOI: 10.1111/aogs.13390] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/22/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Fetal heart rate short term variation (STV) decreases with severe chronic hypoxia in the antenatal period. However, only limited research has been done on STV during labor. We have tested a novel algorithm for a valid baseline estimation and calculated STV. To explore the value of STV during labor, we compared STV with fetal scalp blood (FBS) lactate concentration, an early marker in the hypoxic process. MATERIAL AND METHODS Software was developed which estimates baseline frequency using a novel algorithm and thereby calculates STV according to Dawes and Redman in up to four 30-minute blocks prior to each FBS. Cardiotocography traces from 1070 women in labor who had had FBS performed on 2134 occasions were analyzed. RESULTS In acidemic cases (lactate >4.8 mmol/L; Lactate Pro™), median STV 30 minutes prior to FBS was 7.10 milliseconds compared with 6.09 milliseconds in the preacidemic (4.2-4.8 mmol/L) and 5.23 milliseconds in the normal (<4.2 mmol/L) groups (P < .05). There was a positive correlation between lactate and STV (rho = 0.16-0.24; P < .05). Median lactate concentration in cases with STV <3.0 milliseconds (n = 160) was 2.3 mmol/L. When 2 FBS were performed within 60 minutes the change rate of lactate correlated to STV (rho = 0.33; P < .001). Cases with increasing lactate concentration had a median STV of 5.29 milliseconds vs 4.41 milliseconds in those with decreasing lactate (P < .001). CONCLUSIONS In the early stages of intrapartum hypoxia, STV increases, contrary to findings regarding chronic hypoxia in the antenatal period. The increase in the adrenergic surge is a likely explanation.
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Affiliation(s)
- Ke Lu
- School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden
| | - Malin Holzmann
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Patient Area Pregnancy and Delivery Care, Karolinska University Hospital, Stockholm, Sweden
| | - Fahrad Abtahi
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Physiology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Kaj Lindecrantz
- School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden.,Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Pelle G Lindqvist
- Patient Area Pregnancy and Delivery Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Nordstrom
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Patient Area Pregnancy and Delivery Care, Karolinska University Hospital, Stockholm, Sweden
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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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