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- Iorizzo, L., et al.
(författare)
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Proposed cutoff for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a large prospective observational study
- 2022
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Ingår i: BJOG: An International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 129:4, s. 636-646
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Determination of lactate in fetal scalp blood (FBS) during labour has been recognised since the 1970s. The internationally accepted cutoff of >4.8mmol/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+0weeks of gestation. Method: Based on the optimal correlation between FBS lactate and cord pH/lactate, only cases with ≤25minutes 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 >10mmol/l and/or lactate >10mmol/l. Results: A total of 3334 women were enrolled of whom 799 were delivered within 25minutes. 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 5.7mmol/l; pH <7.0 AUC 0.83 (95% CI 0.68–0.97), cutoff 4.6mmol/l; pH <7.05 plus BDecf ≥12mmol/l AUC 0.97 (95% CI 0.92–1), cutoff 5.8mmol/l; Apgar score <7 at 5minutes AUC 0.74 (95% CI 0.63–0.86), cutoff 5.2mmol/l; and pH <7.10 plus composite neonatal outcome AUC 0.76 (95% CI 0.67–0.85), cutoff 4.8mmol/l. Conclusion: A scalp lactate level <5.2mmol/l using the StatstripLactate®/StatstripXpress® system will safely rule out fetal metabolic acidosis. Tweetable abstract: Scalp blood lactate <5.2mmol/l using the StatstripLactate®/StatstripXpress system has an excellent ability to rule out fetal acidosis.
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- Iorizzo, L., et al.
(författare)
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Use of Lactate ProTM2 for measurement of fetal scalp blood lactate during labor – proposing new cutoffs for normality, preacidemia and acidemia : a cross-sectional study
- 2019
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Ingår i: Journal of Maternal-Fetal and Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 32:11, s. 1762-1768
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Measurement of fetal scalp blood lactate is a supplementary tool to cardiotocography in the case of a non-reassuring tracing. Several hand-held lactate meters have been launched, all with differentials in absolute values. Therefore, the reference intervals must be calculated for each device. The internationally accepted reference interval is based on measurement with Lactate ProTM with recently got out of production. The aim of this study was to propose cutoffs for normality, preacidemia, and acidemia in fetal scalp blood for Lactate ProTM2 based on the comparison of lactate values measured with Lactate ProTM and Lactate ProTM2. Design: Seven hundred one fetal scalp blood samples were analyzed simultaneously. The conversion equations were retrieved from the linear regression model. On the basis of the cutoffs for Lactate ProTM cutoffs for Lactate ProTM2 were calculated. Results: The conversion equations obtained were Lactate ProTM = −0.02 + 0.68 × Lactate ProTM2 (SD: −0.09–0.07 × Lactate ProTM2) and Lactate proTM2 (LP2) = 0.03 + 1.48 × Lactate ProTM (SD: 0.16 + 0.17 × Lactate ProTM). The correlation to umbilical arterial pH was identical for the two devices (r = −0.18), whereas the correlation to umbilical arterial lactate was better for Lactate ProTM than for Lactate ProTM2 (r = 0.38, respectively, r = 0.33). The correlation to umbilical arterial lactate was dependent on time from sampling to delivery. Conclusion: Proposed reference values for Lactate ProTM2: scalp lactate <6.3 mmol/L = normal, no indication for intervention; 6.3–7.1 mmol/L = preacidemia, repeated testing has to be considered; > 7.1 mmol/L = acidemia, expedite delivery.
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