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Association between adverse neonatal outcome and lactate concentration in amniotic fluid
Eva Wiberg-Itzel1, Helena Akerud, Ellika Andolf
1From the Department of Clinical Science and Education, Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital, Stockholm, Sweden; the Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; the Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institute, Danderyd Hospital, Danderyd, Sweden; the Department of Clinical Sciences and Education, Sachs Children's Hospital, Karolinska Institute, Soder Sjukhuset, Stockholm, Sweden; and the Department of Obstetrics and Gynecology, Sahlgrenska University Hospital East, Gothenburg, Sweden.
Objective:
To estimate whether a high lactate concentration in amniotic fluid, together with cardiotocography, can be used as an indicator for an increased risk of adverse neonatal outcome at delivery.
Method:
A prospective cohort study was performed at two tertiary center labor wards in Sweden. Healthy women with full-term, singleton pregnancies and cephalic presentation in spontaneous active labor were included in the study (N=825). Lactate concentration in samples of amniotic fluid collected in the course of vaginal examinations during labor were correlated with cardiotocography 30 minutes before delivery and a composite score for adverse neonatal outcome.
Results:
High lactate concentration in amniotic fluid (greater than 10.1 mmol/L) was associated with an adverse neonatal outcome (odds ratio [OR] 4.4, 95% confidence interval [CI] 2.3-8.2). Fetal bradycardia within 30 minutes before delivery was also associated with an increased risk of adverse neonatal outcome (OR 7.4, 95% CI 3.04-18.11). If lactate in amniotic fluid was greater than 10.1 mmol/L and bradycardia was seen together, the risk of delivering a neonate with an adverse neonatal outcome was increased 11-fold (OR 10.7, 95% CI 3.7-31.7).
Conclusion:
High lactate concentration in amniotic fluid and fetal bradycardia during the last 30 minutes before delivery indicate an increased risk of adverse neonatal outcome at delivery.
