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: 0.56). 07/2002; 31(4):352-7.
Source: PubMed


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.
    Full-text · Article · Aug 2008 · European Journal of Obstetrics & Gynecology and Reproductive Biology
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    ABSTRACT: To compare two techniques of lactate measurements in cord blood: either by electrochemical strip method with Lactate Pro of KDK in the umbilical artery alone (series 1) or by enzymatic method with Rapid lab Analyzer of Bayer in the two vessels (series 2) with acid base balance being also determined. Series 1 included 353 neonates with a mean gestational age of 37 (+/- 3.6) weeks and series 2 included 410 newborns with a mean gestational age of 38 (+/- 3.1) weeks. Data was presented as mean and SD. In the first series mean umbilical artery lactate concentration was 3.71 (+/- 1.81) mmol/l. In the second series mean umbilical artery blood gas and lactate levels were as follows: pH = 7.25 (+/- 0.9), pCO2 = 6.55 (+/- 1.39) kPa; BD = 6.61 (+/- 3.33) mmol/l, lactate 3.92 (+/- 1.81) mmol/l. The 3rd percentile of pH was 7.05 whereas the 97th percentile of lactate was 7.54 mmol/l. There was a close correlation between lactate and pH, and lactate and BD. Lactate concentration was higher in case of instrumental delivery compared to spontaneous one: 4.65 versus 3.76 mmol/l (p = 0.0001, Student test). No perfect correlation was found between lactate level and neonatal outcome but there was not a significant number of neonates with immediate complication. Lactate measurements obtained with single use strip method are valuable and easy to perform.
    No preview · Article · Jan 2004 · Journal de Gynécologie Obstétrique et Biologie de la Reproduction
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    ABSTRACT: Rapid microanalysis of lactate on fetal blood sampling is a new and useful method for fetal monitoring during labor, mainly because of the short lecture delay (1 min) and of the minimal necessary blood volume (5 microl). The lactatometer has the same size as a capillar glucometer and is not expensive. In comparison with pH, it has the advantage of determining metabolic acidosis. According to its excellent specificity in the diagnosis of fetal asphyxia, the lactate microanalysis is a useful complementary method for the fetal heart rate monitoring, the sensibility of which is well-known. A systematic measure of lactate in umbilical artery is an excellent means for self-education in the interpretation of fetal heart rate anomalies, and objective measure for evaluating the quality of intrapartum care and a well-suited defense against litigation, in combination with the 5 min Apgar score.
    No preview · Article · Apr 2004 · Gynécologie Obstétrique & Fertilité
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