• The practical significance of lactate levels in fetal blood at his urgent condition

The practical significance of lactate levels in fetal blood at his urgent condition

HEALTH OF WOMAN.2017.1(117):120–122; doi 10.15574/HW.2017.117.120

Pehnyo N. V.
National Medical Academy of Postgraduate Education P. L. Shupyk, Kiev

The objective: to establish whether the level of lactate in the blood of the fetus to be reliable criterion of his suffering and indication for changing tactics of childbirth.

Patients and methods. The study included 511 pregnant women. Criteria for inclusion in the study: full-term births with singleton pregnancy, cephalic presentation fetus, the absence of membranes, opening the cervix 3 cm or more, according KTG questionable fetus. Included in the study are pregnant randomized into 2 groups.

In the study group included 253 women in childbirth, in which the fetus at CTG rated as doubtful and determine the level of lactate in the blood taken from the skin presenting fetal head. The level of lactate measured succinct method using commercial strip test (Lactate Pro, Arkray, Kyoto, Japan). Tactics delivery determined according to the lactate levels: at <4.2 mmol / l – of delivery according to obstetric situation; 4.2-4.8 mmol / l – research again after 20 minutes; If normal level of lactate – of delivery according to obstetric situation; in the absence of normalization or improvement – prompt delivery; by level of> 4.8 mmol/l-emergency operative delivery.

In the comparison group included 258 rodil with questionable condition of the fetus, which determine the level of lactate was not performed. Tactics birth in this group of patients was determined in accordance with the guidelines and regulations of Ministry of Health of Ukraine.

Results. Proven method of determining the level of fetal blood lactate is technically simple to quickly get results, well tolerated,  no significant complications. The level of fetal blood lactate is a sensitive marker of fetal urgent and therefore is a useful criterion for changing tactics of childbirth. As a result of proven algorithm was able to improve the newborn while reducing the frequency of operative delivery, which was 18.2% in rodil main group and 33.72% in the comparison group (p <0.01).

Conclusion. 1. Determination of lactate in the blood taken from the skin of the fetal head presenting succinct method using commercial strip test (Lactate Pro, Arkray, Kyoto, Japan), to quickly obtain data on the availability of fetal acidosis.

2. The level of lactate in the blood of the fetus can serve as a diagnostic criterion of his suffering and indication for changing tactics of labor in this regard.

3. Simplicity and speed of this technique allows to recommend it for use in obstetric practice.

Key words: urgent fetus, fetal blood lactate, tactics delivery.

REFERENCES

1. East CE, Leader LR, Sheehan P, Henshall NE, Colditz PB. 2010. Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace. Cochrane Database Syst Rev (3):CD 006174.

2. Kruger K, Hallberg B, Blennow M, Kublickas M, Westgren M. 1999. Predictive value of fetal scalp blood lactate concentration and pH as markers of neurologic disability. Am J Obstet Gynecol 181:1072–8. https://doi.org/10.1016/S0002-9378(99)70083-9

3. Ramanah R, Martin A, Rieth-muller D. 2005. Value of fetal scalp lactate sampling during labour: a comparative study with scalp pH. Gynecol. Obstet. Fertil. 33;3:107–112. https://doi.org/10.1016/j.gyobfe.2005.01.004; PMid:15848081

4. Chandraharan E. 2014. Fetal scalp blood sampling during labour: is it a useful diagnostic test or a historical test that no longer has a place in modern clinical obstetrics BJOG 121:1056–62. https://doi.org/10.1111/1471-0528.13162; https://doi.org/10.1111/1471-0528.12614; https://doi.org/10.1111/1471-0528.13125

5. National Institute for Health and Care Exellence. Inpartum care: case of healthy women and their babies during child-bihrth. NICE clinical guideline 190, (Manchester): NICE. 2014.

6. Martin A. 2003. Fetal heart rate during labour: definitions and interpretations. J Gynecolog. Obstet. Biol. Reprod. Paris. 37(Suppl. 1):S34–S35. https://doi.org/10.1016/j.jgyn.2007.11.009; PMid:18191915

7. Holzmann M, Wretler S, Cnat-tingius S, Nordstrim L. 2014, Jun 10. Cardio tocography patterns and risk of inpartum fetal fcidemiya. J. Perinat. Med.

8. MacLennan A. 1999. A template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement. Br. Med. J. 319:1054–1059. https://doi.org/10.1136/bmj.319.7216.1054

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