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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

492
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm
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How should we interpret lactate in labour? A reference study.

Samuel Dockree1, Joseph O'Sullivan1, Brian Shine2

  • 1Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

BJOG : an International Journal of Obstetrics and Gynaecology
|July 22, 2022
PubMed
Summary
This summary is machine-generated.

Maternal lactate levels commonly increase during labor and the postpartum period, with levels rarely exceeding 4 mmol/l. This upper limit may serve as a useful marker for sepsis management in laboring patients.

Keywords:
infectionlabourlactateperinatalpuerperiumsepsis

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Clinical Chemistry

Background:

  • Lactate and C-reactive protein (CRP) are biochemical markers used in clinical practice.
  • Understanding normative lactate levels during labor and the puerperium is crucial for accurate sepsis assessment.
  • Existing evidence for using lactate and CRP to guide antibiotic decisions around delivery is limited.

Purpose of the Study:

  • To investigate maternal lactate concentrations during labor and the puerperium.
  • To determine the normative distribution of lactate and CRP in relation to birth mode.
  • To assess the proportion of lactate results exceeding common clinical cut-offs.

Main Methods:

  • Retrospective review of electronic patient records from a tertiary obstetric unit.
  • Inclusion of 1279 women with term pregnancies and good perinatal outcomes.
  • Analysis of lactate and CRP levels measured on the day of delivery or within 24 hours postpartum, excluding cases with high sepsis likelihood.

Main Results:

  • Maternal lactate levels ranged from 0.4-5.4 mmol/l (median 1.8 mmol/l).
  • Lactate was significantly higher in women with vaginal deliveries compared to cesarean sections (p < 0.001).
  • CRP was significantly higher in women with cesarean sections compared to vaginal deliveries (p < 0.001); 40.8% had lactate ≥2 mmol/l, and 95.3% had lactate <4 mmol/l.

Conclusions:

  • Maternal lactate levels are frequently elevated during labor and the puerperium compared to non-pregnant individuals.
  • The upper limit of lactate at 4 mmol/l may be a valuable indicator for sepsis severity assessment in laboring women.
  • Further research is needed to establish the utility of lactate and CRP in guiding antibiotic therapy decisions during the peripartum period.