[Microvolume dosage of lactate in cord blood for the evaluation of the neonatal well-being].

Service d'Obstétrique et de Médecine Foetale, Hôpital Mère et Enfant, 7, quai Moncousu, 44093 Nantes Cedex, France.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction (Impact Factor: 0.62). 07/2002; 31(4):352-7.
Source: PubMed

ABSTRACT A preliminary experience about a new microvolume lactate meter (Lactate Pro) is reported from 200 consecutive term deliveries. Comparison between lactate and pH in umbilical artery revealed a significant negative correlation between the two variables (r=-0.0693; p<0.0001). For the diagnosis of acidosis (pH<7.15) a lactate cutoff value at 6 mmol/l had a sensitivity of 50% and a specificity of 92% in a population with a prevalence of 8%. The study also demonstrated a better correlation between the concentrations of lactate and the base excess from 44 cord blood samples in high risk deliveries (r=0.837; p<0.0001). A lactate value higher than 6mmol/L predicted a metabolic acidosis (BE>- 8 mmol/l) with a sensitivity of 50% and a specificity of 94% from a collective with a prevalence of 16%. Considering the simplicity of the method, lactate measurements in cord blood could be extended to all birth centers for a systematic evaluation of the fetal condition in combination with the APGAR score. According to the minimal sampling volume (5 microliter) and the better prediction of metabolic acidosis this new method could replace the determination of the pH on fetal scalp.

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    • "Westgren found that mean values of lactate concentrations differed according to different delivery populations: 2.65 AE 1.2 mmol/l (AE1S.D.) by vacuum extraction, 2.44 AE 1.7 mmol/l (AE1S.D.) by emergency caesarean, and 1.87 AE 0.94 mmol/l (AE1S.D.) by spontaneous vaginal delivery [1]. The lactate cut-off value at 8 mmol/l found in this study is also relatively high compared to other studies where cut-off levels from 3.2 to 7.0 mmol/l have been suggested [1] [20] [23] [24]. One reason could be the use of different methods of measurement: a test strip method versus full blood gas analysis. "
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    ABSTRACT: The aim of the present study was (1) to evaluate the relationship between umbilical cord arterial blood lactate and pH, standard base excess (SBE), and actual base excess (ABE) at delivery and (2) to suggest a cut-off level of umbilical cord arterial blood lactate in predicting fetal asphyxia using ROC-curves, where an ABE value less than -12 was used as "gold standard" for significant intrapartum asphyxia. This is a descriptive study of umbilical cord arterial blood samples from 2554 singleton deliveries. The deliveries took place at the Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Copenhagen, Denmark where umbilical cord blood sampling and blood gas analysis is part of the routine assessment of all newborns. We found significant correlations between lactate and pH (r=-0.73), lactate and SBE (r=-0.76), and lactate and ABE (r=-0.83). ROC-curves suggested a lactate cut-off level of 8mmol/l for indicating intrapartum asphyxia. Lactate in arterial umbilical cord blood might be a more direct and accordingly more correct indicator of fetal asphyxia at delivery than pH and SBE (or ABE). Its potential as a predictor of neonatal outcome needs to be evaluated in future studies.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 08/2008; 139(1):16-20. DOI:10.1016/j.ejogrb.2007.10.004 · 1.63 Impact Factor
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    ABSTRACT: The wide use of continuous of fetal heart rate monitoring (FHR) since the seventies has been accompanied by an increase in cesarean delivery rates, without any decrease in cerebral palsy rate. Second line methods of fetal monitoring have been developed in order to better identify fetuses truly at risk of intrapartum asphyxia. The use of fetal scalp blood sampling (FBS) for fetal monitoring seems logical since neonatal acidosis is one of the major criteria of birth asphyxia. Studies show that the use of FBS reduces the increase in cesarean deliveries associated with the use of continuous FHR monitoring. However, FBS is invasive, non continuous and technically uneasy, with a rather high rate of failed blood samplings. Fetal scalp lactates measurement by micromethod requires a much smaller volume of blood. Although a wider assessment is required, the predictive value of fetal blood lactates seems to be similar to that of fetal scalp blood pH.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 03/2008; 37 Suppl 1:S65-71. DOI:10.1016/j.jgyn.2007.11.012 · 0.62 Impact Factor
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    ABSTRACT: Intrapartum asphyxia is defined as metabolic acidemia measured at birth with pH less than 7.00 and base deficit greater or equal to 12 mmol/l. Neonatal complications of intrapartum asphyxia include multiorgan failure and neonatal encephalopathy. Most severe consequences are death and neurological or sensorial impairment. Cause of permanent neurological impairment can be attributed to intrapartum asphyxia if three criteria are met: intrapartum history of a threatening event with acute fetal heart rate deterioration, biological markers of asphyxia, neonatal encephalopathy. Moderate to severe neonatal encephalopathy in asphyxiated term infants is associated with a high risk of cerebral palsy (especially quadriplegic or dyskinetic type) and/or cognitive disorders. Prognosis of neonatal encephalopathy can be accurately assessed by MR imaging.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 03/2008; 37 Suppl 1:S7-15. DOI:10.1016/j.jgyn.2007.11.006 · 0.62 Impact Factor
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