Abstract
ObjectiveTo correlate the value of lactate in fetal scalp blood at delivery and the outcomes of the offspring at four years of age.MethodsCases where scalp blood lactate was taken within sixty minutes before delivery were identified from the randomized trial "Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress”. Data were grouped according to the generally accepted cutoffs for normality, pre-acidemia, acidemia and concentrations above mean +2 SD during the second stage. The outcome measures included gross-/fine motor function, vision, hearing, speaking and cognitive disorders, signs of central motor damage and referral to specialized pediatric services.Results307 cases were available for final analyse. With normal scalp lactate concentration, the number of children with a diagnosed disorder was lower compared to the pre-acidemic/acidemic groups, although the findings were only significant for fine motor dysfunction (p = 0.036). Elevated lactate values were significantly associated with increased risk for a poorer capacity of attention and understanding of instructions (OR 1.37, 95% CI 1.07–1.74), and for fine motor dysfunction (OR 1.22, 95% CI 1.00–1.49) at the age of four.ConclusionHigher levels of lactate in fetal scalp blood seems to be associated with increased risk of an aberrant developmental outcome at four years of age in some areas.
Highlights
The key purpose of fetal surveillance is to ensure fetal wellbeing
With normal scalp lactate concentration, the number of children with a diagnosed disorder was lower compared to the pre-acidemic/ acidemic groups, the findings were only significant for fine motor dysfunction (p = 0.036)
Elevated lactate values were significantly associated with increased risk for a poorer capacity of attention and understanding of instructions, and for fine motor dysfunction at the age of four
Summary
The key purpose of fetal surveillance is to ensure fetal wellbeing. Interventions are performed with the aim of improving short- and long-term morbidity and neurological outcome. CTG is characterized by a high intra- and inter-observer variation and a low positive predictive value for adverse outcome, resulting in a variable but inappropriately high operative delivery rate[3]. A few methods have been proposed as an accessory assessment to CTG, including fetal scalp blood sampling (FBS) to better decide whether to manage the case expectantly or intervene for better neonatal outcome[4,5]. Studies have shown that lactate in scalp blood has better or equal predictive and preventive properties compared to pH in the identification of metabolic acidemia, low Apgar score and short-term neonatal morbidity with no significant difference in the rate of operative deliveries [9,10]. The long-term outcome for children managed by fetal scalp blood lactate sampling during labor is unknown
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