[Commentary on] Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress: randomized controlled multicenter trial.
Analyzing fetal scalp blood pH has been viewed as an effective means of identifying intrapartum fetal hypoxia using 7.20 as a cutoff value. Analyzing pH is, however, complicated and requires up to 50 [mu]l of blood. Lactate, a metabolite of anaerobic metabolism, also reflects tissue hypoxia. Its pre...
| Publicado en: | Obstetrical & Gynecological Survey Vol. 63; no. 11; pp. 687 - 690 |
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| Autor principal: | |
| Formato: | abstract commentary Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
2008 Nov
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105578318&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105578318 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00297828 4EV jtl: Obstetrical & Gynecological Survey issn: 00297828 maglogo: N pubinfo: dt: 2008 Nov vid: 63 iid: 11 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 105578318 105578318 2010106957 105578318 ppf: 687 ppct: 3 formats: tig: atl: [Commentary on] Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress: randomized controlled multicenter trial. aug: au: Rouse DJ sug: subj: Acidosis, Lactic Prevention and Control Fetal Anoxia Diagnosis Fetal Blood Fetal Distress Prevention and Control Lactic Acid Blood Scalp Blood Supply Electrocardiography Fetal Monitoring Methods Fetal Surgery Adverse Effects Fetus Heart Rate, Fetal Evaluation Perinatal Care Fetus, conception to birth ab: Analyzing fetal scalp blood pH has been viewed as an effective means of identifying intrapartum fetal hypoxia using 7.20 as a cutoff value. Analyzing pH is, however, complicated and requires up to 50 [mu]l of blood. Lactate, a metabolite of anaerobic metabolism, also reflects tissue hypoxia. Its predictive value for identifying short-term neonatal morbidity reportedly at least rivals that of pH analysis.In this randomized, controlled, multicenter trial, which enrolled women at a gestational age of at least 34 weeks who had clinical indications for fetal scalp blood sampling, standard pH analysis (n = 1496) was compared with lactate analysis in the same number of patients. Cutoff levels for intervention were 7.21 for pH and more than 4.8 mmol/L for lactate. The major outcomes were metabolic acidemia (pH less than 7.05 and base deficit greater than 12 mmol/L) and a pH below 7.00 in cord artery blood.The incidence of metabolic acidemia was 3.2% in the lactate group and 3.6% in the pH group. The relative risk was 0.91, with a 95% confidence interval of 0.61-1.36. A pH less than 7.00 was recorded in 1.5% of the lactate group and 1.8% of the pH group (relative risk, 0.84; 95% confidence interval, 0.47-1.50). No significant group differences were found in 5-minute Apgar scores less than 7 or rates of operative delivery for fetal distress. Each group included 6 cases of hypoxic ischemic encephalopathy. None of the 3 neonatal deaths in the first week of life-which were all in the pH group-had acidemia at the time of birth. Sampling error was more frequent in the pH group.The findings in this large-scale study suggest that analyzing fetal scalp blood samples for either pH or lactate is helpful in identifying and managing intrapartum hypoxia and preventing acidemia at birth. Performing both is not recommended, as this likely would increase the number of interventions without lessening the risk of metabolic acidemia. pubtype: Academic Journal doctype: abstract commentary Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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