Scalp blood lactate for intra-partum assessment of fetal metabolic acidosis.

Abstract:

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 center. 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 Spearman's rho correlation coefficient. Lactate cut-off values indicating either reassuring fetal status or immediate intervention were estimated using percentile distribution and compared with pH and BD. MAIN OUTCOME MEASURES:Metabolic acidosis, defined as umbilical cord artery pH below 7.05 and 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 the 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

Heinis AM,Spaanderman ME,Gunnewiek JM,Lotgering FK

doi

10.1111/j.1600-0412.2011.01237.x

subject

Has Abstract

pub_date

2011-10-01 00:00:00

pages

1107-14

issue

10

eissn

0001-6349

issn

1600-0412

journal_volume

90

pub_type

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