Umbilical cord blood lactate: A valuable tool in the assessment of fetal metabolic acidosis

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 139; no. 1; pp. 16 - 20
• Main Authors: Gjerris, Anne Cathrine, Stær-Jensen, Jette, Jørgensen, Jan Stener, Bergholt, Thomas, Nickelsen, Carsten
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.07.2008; Elsevier
• Subjects: Acidosis, Lactic - blood; Acidosis, Lactic - diagnosis; Biological and medical sciences; Blood Gas Analysis; Fetal Blood - chemistry; Fetal Diseases - blood; Fetal Diseases - diagnosis; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Lactate; Lactic Acid - blood; Medical sciences; Metabolic acidosis; Newborn assessment; Obstetrics and Gynecology; Reference Values; ROC Curve; Umbilical cord blood; Umbilical cord blood; Lactate; Metabolic acidosis; Newborn assessment; Human; Gynecology; Obstetrics; Blood; Pregnancy; Lactates; Newborn; Fetus; Lactic acid; Umbilical cord
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2007.10.004

Abstract Objective 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. Study design 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. Results 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 8 mmol/l for indicating intrapartum asphyxia. Conclusion 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.