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

Iorizzo, L. LU ; Carlsson, Y. ; Johansson, C. ; Berggren, R. ; Herbst, A. LU ; Wang, M. ; Leiding, M. ; Isberg, P. E. LU ; Kristensen, K. LU and Wiberg-Itzel, E. , et al. (2022) In BJOG: An International Journal of Obstetrics and Gynaecology 129(4). p.636-646
Abstract

Objective: Determination of lactate in fetal scalp blood (FBS) during labour has been recognised since the 1970s. The internationally accepted cutoff of >4.8 mmol/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... (More)

Objective: Determination of lactate in fetal scalp blood (FBS) during labour has been recognised since the 1970s. The internationally accepted cutoff of >4.8 mmol/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+0 weeks of gestation. Method: Based on the optimal correlation between FBS lactate and cord pH/lactate, only cases with ≤25 minutes 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 >10 mmol/l and/or lactate >10 mmol/l. Results: A total of 3334 women were enrolled of whom 799 were delivered within 25 minutes. 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 5.7 mmol/l; pH <7.0 AUC 0.83 (95% CI 0.68–0.97), cutoff 4.6 mmol/l; pH <7.05 plus BDecf ≥12 mmol/l AUC 0.97 (95% CI 0.92–1), cutoff 5.8 mmol/l; Apgar score <7 at 5 minutes AUC 0.74 (95% CI 0.63–0.86), cutoff 5.2 mmol/l; and pH <7.10 plus composite neonatal outcome AUC 0.76 (95% CI 0.67–0.85), cutoff 4.8 mmol/l. Conclusion: A scalp lactate level <5.2 mmol/l using the StatstripLactate®/StatstripXpress® system will safely rule out fetal metabolic acidosis. Tweetable abstract: Scalp blood lactate <5.2 mmol/l using the StatstripLactate®/StatstripXpress system has an excellent ability to rule out fetal acidosis.

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type
Contribution to journal
publication status
published
subject
keywords
Cardiotocography and point of care, fetal monitoring, fetal scalp blood, intrapartum asphyxia, lactate, metabolic acidosis, umbilical cord blood
in
BJOG: An International Journal of Obstetrics and Gynaecology
volume
129
issue
4
pages
636 - 646
publisher
Wiley-Blackwell
external identifiers
  • scopus:85116338848
  • pmid:34555249
ISSN
1470-0328
DOI
10.1111/1471-0528.16924
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
id
ce3dc88b-4be9-4e1a-8720-dd1db6c0aef1
date added to LUP
2021-11-01 13:51:59
date last changed
2024-06-16 22:24:21
@article{ce3dc88b-4be9-4e1a-8720-dd1db6c0aef1,
  abstract     = {{<p>Objective: Determination of lactate in fetal scalp blood (FBS) during labour has been recognised since the 1970s. The internationally accepted cutoff of &gt;4.8 mmol/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<sup>®</sup>/StatstripXpress<sup>®</sup> 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<sup>+0</sup> weeks of gestation. Method: Based on the optimal correlation between FBS lactate and cord pH/lactate, only cases with ≤25 minutes from FBS to delivery were included in the final calculations. Main outcome measures: Metabolic acidosis in cord blood defined as pH &lt;7.05 plus BD<sub>ecf</sub> &gt;10 mmol/l and/or lactate &gt;10 mmol/l. Results: A total of 3334 women were enrolled of whom 799 were delivered within 25 minutes. 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 5.7 mmol/l; pH &lt;7.0 AUC 0.83 (95% CI 0.68–0.97), cutoff 4.6 mmol/l; pH &lt;7.05 plus BD<sub>ecf</sub> ≥12 mmol/l AUC 0.97 (95% CI 0.92–1), cutoff 5.8 mmol/l; Apgar score &lt;7 at 5 minutes AUC 0.74 (95% CI 0.63–0.86), cutoff 5.2 mmol/l; and pH &lt;7.10 plus composite neonatal outcome AUC 0.76 (95% CI 0.67–0.85), cutoff 4.8 mmol/l. Conclusion: A scalp lactate level &lt;5.2 mmol/l using the StatstripLactate<sup>®</sup>/StatstripXpress<sup>®</sup> system will safely rule out fetal metabolic acidosis. Tweetable abstract: Scalp blood lactate &lt;5.2 mmol/l using the StatstripLactate<sup>®</sup>/StatstripXpress system has an excellent ability to rule out fetal acidosis.</p>}},
  author       = {{Iorizzo, L. and Carlsson, Y. and Johansson, C. and Berggren, R. and Herbst, A. and Wang, M. and Leiding, M. and Isberg, P. E. and Kristensen, K. and Wiberg-Itzel, E. and McGee, T. and Wiberg, N.}},
  issn         = {{1470-0328}},
  keywords     = {{Cardiotocography and point of care; fetal monitoring; fetal scalp blood; intrapartum asphyxia; lactate; metabolic acidosis; umbilical cord blood}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{636--646}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{BJOG: An International Journal of Obstetrics and Gynaecology}},
  title        = {{Proposed cutoff for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes : a large prospective observational study}},
  url          = {{http://dx.doi.org/10.1111/1471-0528.16924}},
  doi          = {{10.1111/1471-0528.16924}},
  volume       = {{129}},
  year         = {{2022}},
}