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  • Iorizzo, L.Lund University,Lunds universitet,Obstetrik och gynekologi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Obstetrics and Gynaecology (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Helsingborg Hospital (author)

Proposed cutoff for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a large prospective observational study

  • Article/chapterEnglish2022

Publisher, publication year, extent ...

  • 2021-10-04
  • Wiley,2022

Numbers

  • LIBRIS-ID:oai:gup.ub.gu.se/310764
  • https://gup.ub.gu.se/publication/310764URI
  • https://doi.org/10.1111/1471-0528.16924DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:147769292URI
  • https://lup.lub.lu.se/record/ce3dc88b-4be9-4e1a-8720-dd1db6c0aef1URI

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  • Language:English

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

Notes

  • 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.

Subject headings and genre

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  • Carlsson, Ylva,1975Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Sahlgrenska University Hospital(Swepub:gu)xcarly (author)
  • Johansson, C.Ystad Hospital (author)
  • Berggren, R.Sahlgrenska University Hospital (author)
  • Herbst, A.Lund University,Lunds universitet,Obstetrik och gynekologi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Obstetrics and Gynaecology (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital(Swepub:lu)gyn-ahe (author)
  • Wang, M.University of Sydney (author)
  • Leiding, M.Skåne University Hospital (author)
  • Isberg, P. E.Lund University,Lunds universitet,Statistiska institutionen,Ekonomihögskolan,Department of Statistics,Lund University School of Economics and Management, LUSEM(Swepub:lu)stat-pis (author)
  • Kristensen, K.Lund University,Lunds universitet,Obstetrik och gynekologi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Obstetrics and Gynaecology (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Gold Coast University Hospital, Southport(Swepub:lu)gyn-kkr (author)
  • Wiberg-Itzel, E.Karolinska Institute,Karolinska Institutet,Stockholm South General Hospital (author)
  • McGee, T.Westmead Hospital,University of Sydney (author)
  • Wiberg, N.Lund University,Lunds universitet,Obstetrisk, gynekologisk och prenatal ultraljudsdiagnostik,Forskargrupper vid Lunds universitet,Obstetric, Gynaecological and Prenatal Ultrasound Research,Lund University Research Groups,Ystad Hospital(Swepub:lu)obst-nwi (author)
  • Obstetrik och gynekologi, LundSektion V (creator_code:org_t)

Related titles

  • In:BJOG: An International Journal of Obstetrics and Gynaecology: Wiley129:4, s. 636-6461470-03281471-0528

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