Fetal scalp blood sampling during second stage of labor - analyzing lactate or pH? A secondary analysis of a randomized controlled trial

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Stål, IngridGothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology (author)

Fetal scalp blood sampling during second stage of labor - analyzing lactate or pH? A secondary analysis of a randomized controlled trial

Article/chapterEnglish2022

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2020-03-31
Informa UK Limited,2022

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LIBRIS-ID:oai:gup.ub.gu.se/292349
https://gup.ub.gu.se/publication/292349URI
https://doi.org/10.1080/14767058.2020.1743656DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:143364169URI

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Language:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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Background: Cardiotocography (CTG) is a widely used method for assessing fetal wellbeing during labor. It is well-known that CTG has high sensitivity but low specificity. To avoid unnecessary operative interventions, adjunctive methods such as fetal blood sampling (FBS) are used. Few studies have looked into whether FBS can be used during second stage of labor, and in that case, which of the methods (lactate or pH) are preferred. Objective: To evaluate clinical effectiveness of measuring lactate versus pH in preventing birth acidemia when FBS was performed during second stage of labor. Methods: Secondary analysis of a randomized controlled trial . Thousand three hundred and thirty-eight women with a singleton pregnancy, cephalic presentation, gestational age >= 34 weeks, and indication for FBS during second stage of labor were included. Main outcome measures: Metabolic acidemia (pH 12 mmol/l) or pH < 7.00 in cord arterial blood at birth. Secondary outcomes: A composite outcome (metabolic acidemia, pH <7 or Apgar score <4), and rates of operative deliveries. Results: Metabolic acidemia occurred in 4.1% in the lactate versus 5.1% in the pH group (relative risk (RR): 0.80; 95% confidence interval (CI): 0.48-1.35) and pH <7 in 1.4% versus 2.8% (RR: 0.51, 95% CI: 0.23-1.13). Composite outcome was found in 3.8 versus 4.9%, respectively (RR: 0.76; 95% CI: 0.46-1.26). No difference in total operative interventions was found. More cesarean deliveries were performed in the lactate group (16.5 vs. 12.4%; RR: 1.33; 95% CI: 1.02-1.74). Conclusion: When analyzing lactate or pH in fetal scalp blood during second stage of labor neonatal outcomes were comparable. The frequency of total operative interventions was similar but more cesarean deliveries were performed in the lactate group.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Reproduktionsmedicin och gynekologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Obstetrics, Gynaecology and Reproductive Medicine hsv//eng
Fetal scalp blood sampling
lactate
pH
second stage of labor
metabolic acidosis
neonatal outcome
cesarean section
human-fetus
cord blood
strip
values
Obstetrics & Gynecology

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Wennerholm, Ulla-Britt,1948Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology(Swepub:gu)xwennu (author)
Nordstrom, L. (author)
Ladfors, Lars,1951Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology(Swepub:gu)xladla (author)
Wiberg-Itzel, E.Karolinska Institutet (author)
Göteborgs universitetInstitutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi (creator_code:org_t)

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In:Journal of Maternal-Fetal & Neonatal Medicine: Informa UK Limited35:6, s. 1100-10071476-70581476-4954

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By the author/editor: Stål, Ingrid; Wennerholm, Ulla ...; Nordstrom, L.; Ladfors, Lars, 1 ...; Wiberg-Itzel, E.

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Obstetrics Gynae ...

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By the university: University of Gothenburg; Karolinska Institutet

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