Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia

Abstract

Despite advances in fetal monitoring during labor, one of the most critical causes of neonatal death and neurologic injuries remains intrapartum asphyxia. Umbilical cord gases can be used to detect acidosis and fetal distress. We conducted a retrospective, multicenter study to evaluate umbilical cord blood pH and lactate as a mean of evaluating the degree of intrapartum hypoxia and also to establish which of the two is more reliable in predicting morbidity in term neonates. The present study utilized a total of 124 cases that met the criteria for intrapartum asphyxia and 150 normal term newborns that were randomly selected as case control. Both umbilical cord lactate and pH proved to be accurate predictors of neonatal morbidity caused by intrapartum hypoxia. Lactate proved to be superior to pH in predicting adverse neonatal outcome. The greatest sensibility and specificity in predicting intrapartum asphyxia were achieved in our study by using a cutoff value of 3.75 mmol/l for lactate and 7.24 for pH.

Keywords: fetal distress; intrapartum asphyxia; intrapartum hypoxia; umbilical cord lactate; umbilical cord pH.

Figure 1

Box plots for pH and lactate values in the IA and Control groups. IA=1, control group; IA=1, IA group; IA, intrapartum asphyxia.

Figure 2

Receiver operating characteristic (ROC) curves of pH and lactate for the diagnosis of IA. IA, intrapartum asphyxia.