Need updating fetal blood sampling guidelines since lactate levels indicating acidemia are specific to the measuring instrument.

Abstract

I read the guest editorial by Holzmann et al1 with great interest. I would like to point out a very important aspect of the findings presented by authors with regard to the problems in the interpretation of lactate values indicating intervention (>4.8 mmol/L) compared with pH <7.20; based on an initial publication by Shimojo et al2 in 1993 with device Lactate Pro 1. The co-author (Lennart Nordström) of this editorial was also a co-author in scientific impact paper no. 47 “Fetal scalp lactate as an alternative to scalp pH, is it time for the UK obstetricians to accept” commissioned by the Royal College of Obstetricians & Gynaecologists.3 This scientific impact paper recommended use of point-of-care handheld devices for fetal blood sampling, where lactate values >4.8 mmol/L were considered acidemic, indicating intervention. However, handheld devices are not commonly used for fetal blood sampling in the UK. Testing is done using different blood gas analyzers. For example we use an ABL90 FLEX PLUS blood gas analyzer in our department.