Практичне значення рівня лактату в крові плода при невідкладному його стані

Abstract

The objective: to establish whether the level of lactate in the blood of the fetus to be reliable criterion of his suffering and indication for changing tactics of childbirth. Patients and methods. The study included 511 pregnant women. Criteria for inclusion in the study: full-term births with singleton pregnancy, cephalic presentation fetus, the absence of membranes, opening the cervix 3 cm or more, according KTG questionable fetus. Included in the study are pregnant randomized into 2 groups. In the study group included 253 women in childbirth, in which the fetus at CTG rated as doubtful and determine the level of lactate in the blood taken from the skin presenting fetal head. The level of lactate measured succinct method using commercial strip test (Lactate Pro, Arkray, Kyoto, Japan). Tactics delivery determined according to the lactate levels: at <4.2 mmol / l – of delivery according to obstetric situation; 4.2-4.8 mmol / l – research again after 20 minutes; If normal level of lactate – of delivery according to obstetric situation; in the absence of normalization or improvement – prompt delivery; by level of> 4.8 mmol/l-emergency operative delivery. In the comparison group included 258 rodil with questionable condition of the fetus, which determine the level of lactate was not performed. Tactics birth in this group of patients was determined in accordance with the guidelines and regulations of Ministry of Health of Ukraine. Results. Proven method of determining the level of fetal blood lactate is technically simple to quickly get results, well tolerated, no significant complications. The level of fetal blood lactate is a sensitive marker of fetal urgent and therefore is a useful criterion for changing tactics of childbirth. As a result of proven algorithm was able to improve the newborn while reducing the frequency of operative delivery, which was 18.2% in rodil main group and 33.72% in the comparison group (p <0.01). Conclusion. 1. Determination of lactate in the blood taken from the skin of the fetal head presenting succinct method using commercial strip test (Lactate Pro, Arkray, Kyoto, Japan), to quickly obtain data on the availability of fetal acidosis. 2. The level of lactate in the blood of the fetus can serve as a diagnostic criterion of his suffering and indication for changing tactics of labor in this regard. 3. Simplicity and speed of this technique allows to recommend it for use in obstetric practice. Key words: urgent fetus, fetal blood lactate, tactics delivery.