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Federación Mexicana de Ginecología y Obstetricia, A.C.

2022, Number 02

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Ginecol Obstet Mex 2022; 90 (02)

Determination of pH and lactate from fetal scalp blood to study the management of intrapartum fetal hypoxia

Rodríguez-Pérez A, Caruso A, Azcona-Sutil L, Pantoja-Garrido M, Brenner-Anidjar RD

Language: Spanish
References: 16
Page: 156-164
PDF size: 179.96 Kb.


ABSTRACT

Objective: To compare the ability to predict adverse intrapartum perinatal outcomes between the determination of pH and lactate by fetal calyceal blood microtomy.
Materials and Methods: Comparative, observational, descriptive and prospective study carried out in pregnant patients, at term, attended from February to October 2019 at the Obstetrics Clinical Management Unit of the Virgen Macarena University Hospital of Seville, Spain. All of them underwent a fetal calyx blood microdrawing during labor and, subsequently, at birth, arterial blood gas analysis of the umbilical cord.
Results: Of 118 determinations obtained, 99 values corresponding to 81 pregnant women were studied. A significant correlation of 76.6% was found between pH and lactate, although both with low sensitivity and low positive predictive value, high specificity and negative predictive value. When predicting the pH value of the umbilical artery, only the pH of the calyx obtained a significant result.
Conclusion: Due to the high negative predictive value and specificity of fetal calyx pH and lactate determination, it was observed that this is a test that should be applied only when confirmation is required, but not as a screening method for fetal well-being. The pH was superior to lactate in estimating the arterial blood gas result of the umbilical cord.


REFERENCES

  1. Tuuli MG, Stout MJ, Shanks A, Odibo AO, Macones GA, Cahill AG. Umbilical Cord Arterial Lactate Compared With pH for Predicting Neonatal Morbidity at Term. Obstet Gynecol 2014; 124 (4): 756-61. doi:10.1097/AOG.0000000000000466

  2. Wiberg-Itzel E, Lipponer C, Norman M, Herbst A, Prebensen D, Hansson A, et al. Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress: randomised controlled multicentre trial. BMJ 2008; 336 (7656): 1284-7. doi: 10.1136/bmj.39553.406991.25.

  3. Calvo Perez A Cabeza Vengoechea PJ, Clar MJ, Trias Rojas J, Aguera Ortiz J. Comparación lactato-pH intramuestral en sangre capilar fetal para el estudio del bienestar fetal intraparto. Prog Obstet Ginecol 2014; 57 (2): 66-70. https://doi.org/10.1016/j.pog.2013.09.007

  4. Pascual Mancho J, Marti Gambo S, Redrado Gimenez O, Crespo Esteras R, Rodriguez Solanilla B, Castan Mateo S. Diagnostic accuracy of fetal scalp lactate for intrapartum acidosis compared with scalp pH. J Perinat Med 2017; 45 (3): 315-20. doi:10.1515/jpm-2016-0044

  5. Bowler T, Beckmann M. Comparing fetal scalp lactate and umbilical cord arterial blood gas values. Aust N Z J Obstet Gynaecol 2014; 54: 79-83. doi: 10.1111/ajo.12144

  6. East CE, Leader LR, Sheehan P, Henshall NE, Colditz PB, Lau R. Cochrane Database of Systematic Reviews. Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace (Review). Cochrane Database of Systematic Reviews, May 2015. https://doi.org/10.1002/14651858.CD006174.pub3

  7. Guía práctica y signos de alarma en la atención al parto. Protocolos de la SEGO- Revisión 2008.

  8. Haverkamp AD, Orleans M, Langendoerfer S, McFee J, Murphy J, Thompson HE. A controlled trial of the differential effects of intrapartum fetal monitoring. Am J Obstet Gynecol 1979; 134 (4): 399-412

  9. Jørgensen JS, Weber T. Fetal scalp blood sampling in labor--a review. Acta Obstet Gynecol Scand 2014; 93 (6): 548-55. doi: 10.1111/aogs.12421. PMID: 24806978

  10. Nordström L. Fetal scalp blood measurements during labour-lactate or pH? Clin Biochem 2011; 44 (7): 456-57. doi: 10.1016/j.clinbiochem.2011.03.007.

  11. Ramanah R, Martin A, Riethmuller D, Maillet R, Schaal JP. Value of fetal scalp lactate sampling during labour: a comparative study with scalp pH. Gynecol Obstet Fertil 2005; 33 (3): 107-12.

  12. Prouhèze A, Girault A, Barrois M, Lepercq J, Goffinet F, Le Ray C. Fetal scalp blood sampling: Do pH and lactates provide the same information? J Gynecol Obstet Hum Reprod 2020 Oct 31:101964. doi: 10.1016/j.jogoh.2020.101964.

  13. Carbonne B, Langer B, Goffinet F, et al. Multicenter study on the clinical value of fetal pulse oximetry. II. Compared predictive values of pulse oximetry and fetal blood analysis. The French Study Group on Fetal Pulse Oximetry. Am J Obstet Gynecol 1997; 177 (3): 593e8.

  14. Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2013 May 31; (5): CD006066. doi: 10.1002/14651858.CD006066

  15. ACOG Practice Bulletin. Intrapartum fetal heart rate monitoring: nomenclature, interpretation and general management principles. Obstet Gynecol 2009; 106: 192-202

  16. Chandraharan E, Wiberg N. Fetal scalp blood sampling during labor: an appraisal of the physiological basis and scientific evidence. Acta Obstet Gynecol Scand 2014; 93 (6): 544-7. doi: 10.1111/aogs.12416




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