Lactate versus pH levels in fetal scalp blood during labor--using the Lactate Scout System

Abstract

Objective: To assess if lactate measured with the Scout Lactate System is a reliable alternative to pH in intrapartum monitoring of the fetus.

Methods: A prospective study analyzing (1) the correlation between scalp lactate measured by the Scout Lactate System and the Automatic Blood Laboratory (ABL), (2) the correlation between lactate and pH measured in scalp blood and (3) the correlation between fetal scalp lactate and umbilical cord SBE. The sensitivity/specificity and positive/negative predictive values of lactate in predicting low pH were analyzed and expressed as Receiver Operating Curves (ROC).

Results: Lactate measured by the Scout Lactate System and the ABL correlated well (r(2)=0.85). Both lactate and pH were measured in 1009 scalp blood samples. The sensitivity and specificity of lactate ≥ 4.8 mmol/l in predicting a pH <7.20 were 0.63 and 0.85, respectively. The correlation between scalp lactate measured within 15 min prior to delivery and the umbilical cord SBE was low.

Conclusion: Monitoring non-reassuring deliveries with scalp lactate instead of pH would have resulted in more (155 instead of 56) instrumental deliveries with no decrease in newborns with severe metabolic acidosis.

Keywords: Neonatal asphyxia; ROC; sensitivity; specificity.