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Scalp blood lactate for intra-partum assessment of fetal metabolic acidosis.
MedLine Citation:
PMID:  21751970     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective. To study to what extent the fetal scalp blood lactate concentration during labor correlates with fetal scalp pH and base deficit, and metabolic acidosis at birth, and to suggest lactate cut-off values to serve as indicators for either reassurance or immediate intervention. Design. A retrospective observational study. Setting. Labor ward at a university medical centre. Sample. Fetal scalp and cord blood samples with acid-base and lactate values from 486 singleton pregnancies beyond 34 weeks gestation. Methods. The relation between lactate, pH and base deficit (BD) in fetal scalp blood was tested by Spearmans's rho correlation coefficient. Lactate cut-off values indicating either reassuring fetal status or immediate intervention were estimated using percentile distribution and compared to pH and BD. Main outcome measures. Metabolic acidosis, defined as umbilical cord artery pH below 7.05 and base deficit (BD) calculated for the blood compartment above 12 mmol/l. Results. After 127 (21%) exclusions, 486 cases were available for analysis. Fetal lactate values increased with evolving metabolic acidosis. Lactate concentration correlated with both pH (r=-0.50, p < 0.01) and BD (r= 0.48, p < 0.01). Lactate < 5.4 mmol/l indicated reassuring fetal status, whereas lactate ≥ 6.6 mmol/l indicated metabolic acidosis. Fetal lactate correlated better with either the absence or presence of metabolic acidosis at birth than did fetal pH and BD. Conclusions. In case of a non-reassuring fetal heart rate, fetal scalp blood lactate provides more accurate information on fetal acid-base status than does pH and/or BD.
Authors:
Ayesha M F Heinis; Marc E Spaanderman; Jacqueline M T Klein Gunnewiek; Fred K Lotgering
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-13
Journal Detail:
Title:  Acta obstetricia et gynecologica Scandinavica     Volume:  -     ISSN:  1600-0412     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-7-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370343     Medline TA:  Acta Obstet Gynecol Scand     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Authors AOGS© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.
Affiliation:
Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands Department of Clinical Chemistry, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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