Cord Blood Lactate Research Articles

Cord Blood pH and Lactate- A Step Ahead in Diagnosis of Fetal Acidaemia in Patients with Abnormal Cardiotocography

OBJECTIVES: Electronic fetal monitoring (EFM) is used to identify early signs of fetal deterioration. However, caution is advised when interpreting cardiotocographic parameters. A promising alternative is umbilical cord blood sampling. The analysis of blood gases and lactate levels in the cord within the ini-tial minutes of life is a recommended approach. STUDY DESIGN: This prospective cohort study, conducted over eighteen months from June 2021 to December 2022, enrolled 70 patients with non-reactive and 70 with reactive cardiotocograph (CTG) pat-terns. APGAR scores were recorded at 1 and 5-minute intervals. 1 ml of umbilical artery blood was as-sessed in an arterial blood gas machine and fetal acidosis was defined as pH <7.0 and a lactate con-centration exceeding 4 mmol/L. RESULTS: In the non-reactive CTG group, 35.7% had early decelerations, 37.1% had variable decel-erations, and 17.1% had late decelerations (p<0.001). The mean cord blood lactate was 5.220±1.970 mmol/L in the non-reactive CTG group and 3.400±0.228 mmol/L in the reactive CTG group. Similarly, the mean cord blood pH was 7.030±0.007 in the non-reactive CTG group and 7.170±0.076 in the reac-tive CTG group (p<0.001). 14.3% of cases in the non-reactive CTG group had a 5-minute APGAR <7, with a higher APGAR score in the reactive group. CONCLUSION: The study suggests that abnormal or indeterminate CTG readings are linked to a higher risk of intrapartum fetal acidosis. Non-reactive CTG results were associated with higher mean cord blood lactate and pH levels and more number of Neonatal Intensive Care Unit (NICU) admissions. There is a definite correlation between abnormal CTG patterns and poorer neonatal outcomes.

Comparison of Apgar scores and cord blood gas parameters in fetuses with isolated congenital heart disease and healthy controls.

This retrospective study aimed to investigate how congenital heart disease (CHD) affects early neonatal outcomes by comparing Apgar scores and umbilical cord blood gas parameters between fetuses with structural cardiac anomalies and healthy controls. Additionally, within the CHD group, the study explored the relationship between these parameters and mortality within six months. Data from 68 cases of prenatally diagnosed CHD were collected from electronic medical records, excluding cases with missing data or additional comorbidities. Only patients delivered by elective cesarean section, without any attempt at labor, were analyzed to avoid potential confounding factors. A control group of 147 healthy newborns was matched for delivery route, maternal age, and gestational week. Apgar scores at 1, 5, and 10 minutes, as well as umbilical cord blood pH, base deficit, and lactate levels, were recorded. Maternal age, gestational week at delivery, and birth weight were similar between the CHD and control groups. While Apgar score distribution was significantly lower at 1st, 5th, and 10th minutes in the CHD group, umbilical cord blood gas parameters did not show significant differences between groups. Within the CHD group, lower umbilical cord blood pH and larger base deficit were associated with mortality within six months. Newborns with CHD exhibit lower Apgar scores compared to healthy controls, suggesting potential early neonatal challenges. Furthermore, umbilical cord blood pH and base deficit may serve as predictors of mortality within six months in CHD cases. Prospective studies are warranted to validate these findings and integrate them into clinical practice, acknowledging the study's retrospective design and limitations.

PREDICTIVE VALUE OF UMBILICAL ARTERIAL BLOOD LACTATE IN NEONATES WITH MECONIUM-STAINED LIQUOR

This research aims to determine the clinical and maternal variables contributing to increased lactate levels and determine the prognostic usefulness of umbilical cord blood lactate levels in neonates through meconium-stained liquor. The study was conducted between 01 June 2022 and 31 May 2023 at the Department of Neonatology, CMH Rawalpindi. This study included 100 newborns with meconium aspiration syndrome (MAS) in a thin cross-sectional design. Newborn babies received treatment at CMH Hospital throughout the approved period, and observations of umbilical cord blood have been obtained for lactate measurement and arterial blood gas analysis. Furthermore, information on post-delivery problems and neonatal features was retrieved using hospital records. The research included comprehensive statistical analyses, encompassing both Bivariate and multivariate evaluations, to pinpoint the variables linked to increased lactate levels and their potential predictive significance for unfavorable neonatal outcomes. This study included 720 unpaired samples of cord blood from the umbilical artery. The lactate result had an interquartile range of 4.0–6.2 mmol/L and a mean of 5.49 mmol/L (± SD 2.44 mmol/L). After birth, resuscitation was required for a considerably more significant number of neonates with increased lactate levels (25.1%) than for those who had lesser lactate levels (1.3%). At five minutes, Apgar scores of less than seven also showed a significant correlation between high lactate levels and a greater incidence of asphyxia (19.8%). Meconium-stained liquor (aOR=5.85), primigravidity (aOR=2.78), male sex (aOR=1.71), and oxytocic administration (OR=1.97) were factors linked to elevated lactate levels. The results highlight the prognostic significance of umbilical cord blood lactate levels in newborn outcomes, particularly while considering the necessity for resuscitation, asphyxia, and diagnosis such as hypoxic encephalopathy. Elevated lactate levels are more likely in cases where maternal and clinical variables are present, such as primigravidity and liquor stained with meconium. This study underscores the feasibility of including lactate measures from umbilical cord blood into standard evaluations of neonates, providing a valuable instrument for prompt identification and remediation. Prospective investigations and multi-center trials are necessary to confirm these results and investigate the long-term effects of increased lactate levels on newborn health.

Знеболювання в пологах - порівняння і аналіз класичної методики епідуральної аналгезії та модифікованої з пункцією твердої мозкової оболонки

Epidural analgesia (EA), most commonly used for labor analgesia, is an effective and relatively safe technique, but may be associated with slow onset, inadequate block. The use of Dural puncture epidural (DPE) is designed to find a balance between improving the quality of analgesia and reducing the frequency of side effects. Purpose - to compare two methods of labor analgesia. Materials and methods. All women (n=80) were divided into two groups: the Group I (n=40) used DPE, the Group II (n=40) used EA. In both groups, the same technique of epidural puncture and catheterization was used, in the Group I additionally puncture of the dura mater. Analgesia was evaluated using the visual analog pain rating scale (VAS). The quality and effectiveness of analgesia, the hemodynamics of the woman were evaluated. Complications and unwanted effects were recorded. Fetal condition: cardiotocography (CTG), umbilical cord blood lactate, pH. A statistical analysis of the obtained data was carried out. Results. The first contraction (VAS1) in the Group I were fixed on 11.43.3 min, and in the Group II on 21.57.2 min (p0.05). Monolateral block in the Group I - 4 (10%) versus 10 (25%) (p0.05). Contractions (VAS 1) after 30 min in the Group II - 7 (17.5%) versus the absence of such in the Group I. Stroke volume in the Group I decreased by 2.1% versus 1.5% in the Group II. The data for hypotension and occurrence of complications, CTG, cord blood lactate, and pH were not different by group. Conclusions. The use of the DPE technique against EA gives better results in terms of the quality and effectiveness of analgesia. The mother’s hemodynamics remained stable when using DPE. The DPE technique does not increase the frequency of complications compared to EA. There was no difference between the groups when assessing the state of the fetus according to CTG data, pH indicators and umbilical cord blood lactate. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author.

Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial

BackgroundIn high resource settings, lactate and pH levels measured from fetal scalp and umbilical cord blood are widely used as predictors of perinatal mortality. However, the same is not true in low resource settings, where much of perinatal mortality occurs. The scalability of this practice has been hindered by difficulty in collecting fetal scalp and umbilical blood sample. Little is known about the use of alternatives such as maternal blood, which is easier and safer to obtain. Therefore, we aimed to compare maternal and umbilical cord blood lactate levels for predicting perinatal deaths.MethodsThis was secondary analysis of data from a randomized controlled trial assessing the effect of sodium bicarbonate on maternal and perinatal outcomes among women with obstructed labour at Mbale regional referral hospital in Eastern Uganda. Lactate concentration in maternal capillary, myometrial, umbilical venous and arterial blood was measured at the bedside using a lactate Pro 2 device (Akray, Japan Shiga) upon diagnosis of obstructed labour. We constructed Receiver Operating Characteristic curves to compare the predictive ability of maternal and umbilical cord lactate and the optimal cutoffs calculated basing on the maximal Youden and Liu indices.ResultsPerinatal mortality risk was: 102.2 deaths per 1,000 live births: 95% CI (78.1–130.6). The areas under the ROC curves were 0.86 for umbilical arterial lactate, 0.71 for umbilical venous lactate, and 0.65 for myometrial lactate, 0.59 for maternal lactate baseline, and 0.65 at1hr after administration of bicarbonate. The optimal cutoffs for predicting perinatal death were 15 0.85 mmol/L for umbilical arterial lactate, 10.15mmol/L for umbilical venous lactate, 8.75mmol/L for myometrial lactate, and 3.95mmol/L for maternal lactate at recruitment and 7.35mmol/L after 1 h.ConclusionMaternal lactate was a poor predictor of perinatal death, but umbilical artery lactate has a high predictive value. There is need for future studies on the utility of amniotic fluid in predicting intrapartum perinatal deaths.

Correlation of umbilical cord blood pH, base deficit, and lactate levels with outcomes of hypoxic newborns: A prospective study

Correlation of umbilical cord blood pH, base deficit, and lactate levels with outcomes of hypoxic newborns: A prospective study

Кардиальная дисфункция у плода: влияние на исходы в перинатальном периоде у недоношенных детей

Objective. To study the importance of fetal cardiac dysfunction in the genesis of perinatal brain damage in premature newborns. Patients and methods. A prospective cohort comparative study included 59 preterm infants with gestational age from 26 to 32 weeks and body weight from 590 to 1990. Newborns were divided into 2 groups at the 1st month of life: the main group (n = 38), which included children with structural brain lesions, and the control group (n = 21) with favorable neurological outcomes. There were no statistically significant differences in either body weight or gestational age between the groups. At the antenatal stage, all underwent ultrasound doppler sonography of uteroplacental blood flow, and the cerebral-placental ratio was calculated. The following markers were determined at the 1st day of postnatal life: levels of lactate, cerebral natriuretic propeptide and soluble type 2 tumor suppressor in the umbilical cord blood of a newborn (enzyme-linked immunosorbent assay); neurosonography of the brain with the determination of blood flow and doppler echocardiography. Neurological outcomes were assessed after 1 month of life after the control neurosonography of brain. The data are presented in the form of median, maximum and minimum values – Me [min; max]. The obtained data were processed using the Statistica 6.1 program. The Mann–Whitney and Fisher χ2 criteria with the Yeats correction were calculated. The differences were considered significant at p equal to 0.05. Results. The pulsation index in the umbilical cord artery was significantly higher (1.270 [1.120; 1.320] versus 0.984 [0.798; 1.120]) in the fetuses of the main group, Its values indicating severe disorders of fetal-placental hemodynamics were more often recorded (in 15–39.5% cases versus 4–19.1%). The significant decrease in the cerebroplacental ratio was significantly more often recorded (in 18–47.4% cases versus 2–9.5%) in the same group. The levels of lactate (3.6 [2.1; 5.2] versus 2.25 [1.3; 3.05] mmol/L) and cerebral natriuretic propeptide (243.2 [84.17; 1385] versus 111.6 [64.8; 2903] pg/ml, respectively) were significantly elevated in the umbilical cord blood, in newborns of the main group. The newborns of the main group had significantly lower levels of systolic, diastolic and mean blood pressure, at the first hours of life. They also had a reduced level of blood flow in the superior vena cava (Me = 65 ml/kg/min; 9 (23.7%) children had a periventricular leukomalacia, 18 (47.4%) – intraventricular hemorrhages of the II–III degree, and 2 (5.3%) had a stroke. Conclusion. It is very important to pay attention of pediatricians-neonatologists to the antenatal period. Treating the fetus as a patient, early assessment of hemodynamics and timely diagnosis of fetal cardiac dysfunction and other developmental abnormalities will reduce the incidence of disabling perinatal diseases and the level of perinatal mortality. Key words: antenatal diagnosis, umbilical cord blood lactate, prematurity, perinatal brain damage, placental insufficiency, fetal cardiac dysfunction

The effect of piglet vitality, birth order, and blood lactate on the piglet growth performances and preweaning survival

BackgroundLitter size is going up in modern pig production. Due to large litter size and increased farrowing duration, newborn piglets, during parturition, can suffer from asphyxiation. This alters their blood energy parameters and can contribute to their reduced vitality at birth, which is detrimental to their growth performance and survival. We aimed to evaluate the effects of vitality score, piglets’ umbilical cord blood lactate, glucose, and butyrate, and birth order on growth performance and the preweaning mortality of piglets.ResultsThe more vital (vitality score 2, VS2) piglets had higher umbilical cord blood glucose and butyrate, lower blood lactate, and higher colostrum intake (CI) at birth, and showed higher body weight at birth and at weaning than did less vital piglets (vitality score 1, VS1). Umbilical cord lactate negatively correlated with vitality, colostrum intake, and growth before weaning. Among the four birth-order groups (BOGs), piglets born earlier during parturition had a higher mean vitality score than those born later. BOG1 and BOG2 had significantly higher CI (p < 0.05) than BOG3 and BOG4.ConclusionChanges in piglets’ body weight, colostrum intake, and umbilical cord lactate are associated with piglet vitality and asphyxiation during farrowing. In addition, asphyxiation induced higher umbilical cord lactate may serve as an indicator of low vitality and low colostrum consumption. Overall, improvement in piglets’ vitality and in the farrowing process can help in reducing piglet mortality.

The Association of Cord Blood Lactate and Thiol-disulfide Homeostasis in Vaginal or Cesarean Delivered Term Newborns (without Fetal Distress)

The Association of Cord Blood Lactate and Thiol-disulfide Homeostasis in Vaginal or Cesarean Delivered Term Newborns (without Fetal Distress)

Maternal obesity-associated disruption of polarized lactate transporter MCT4 expression in human placenta

Maternal obesity is associated with an increased risk of adverse pregnancy outcomes including stillbirth, and their etiology is thought to be related to placental and fetal hypoxia. In this study, we sought to investigate the levels of lactate in maternal and umbilical cord blood, a well characterized biomarker for hypoxia, and expression of plasma membrane lactate transporter MCT1 and MCT4 in the placental syncytiotrophoblast (STB), which are responsible for lactate uptake and extrusion, respectively, from pregnant women with a diagnosis of obesity following a Cesarean delivery at term. With use of approaches including immunofluorescence staining, Western blot, RT-qPCR and ELISA, our results revealed that in controls the expression of MCT1 was equally observed between basal (fetal-facing, BM) and microvillous (maternal-facing, MVM) membrane of the STB, whereas MCT4 was predominantly expressed in the MVM but barely detected in the BM. However, obese patients demonstrated significant decreased MCT4 abundance in the MVM coupled with concurrent elevated expression in the BM. We also found a linear trend toward decreasing MCT4 expression ratio of MVM to BM with increasing maternal pre-pregnancy BMI. Furthermore, our data showed that the lactate ratios of fetal cord arterial to maternal blood were remarkably reduced in obese samples compared to their normal counterparts. Collectively, these results suggest that the loss of polarization of lactate transporter MCT4 expression in placental STB leading to disruption of unidirectional lactate transport from the fetal to the maternal compartment may constitute part of mechanisms linking maternal obesity and pathogenesis of stillbirth.

The evaluation of amniotic fluid lactate level in predicting cesarean delivery and early neonatal acidemia

AIM&#x0D; Evaluate whether lactate increase in amniotic fluid influences cesarean delivery or correlation of this increase with oxytocin induction and early neonatal blood gas parameters.&#x0D; METHODS&#x0D; We designed this prospective study of 408 pregnant women. We divided the groups as vaginal delivery (n=184), emergency cesarean (n=46), and planned cesarean delivery (n=178). We evaluated the AFL values in terms of being associated with labor outcomes and neonatal blood gas parameters.&#x0D; RESULTS&#x0D; AFL level was different between all three groups. Cord blood pH, lactate values, and maternal age were different between the groups. We analyzed the AFL level and cord blood lactate (CBL) values according to acidemia. The group's lactate levels with a pH

Comparaison de la mesure des lactates au cordon par des appareils portatifs ayant l’habilitation pour une utilisation pendant le travail avec un appareil de référence

ObjectiveTo compare two portable lactate devices, Lactate Scout and StatStrip Xpress, to a laboratory reference device by assessing the concordance of cord blood lactate values at birth. MethodsWe conducted a single-center prospective validation study in a level 3 maternity hospital. For all cord samples taken at birth, we analyzed lactates on the reference device (GEM4000®) and on two portable devices Lactate Scout and StatStrip Xpress. We compared the lactate values from each of the two handheld devices to the reference device. ResultsA total of 101 samples were collected. Each was analyzed by all three machines. The average lactate value obtained by the different machines was 3.7mmol/L. The mean difference between the Lactate Scout and GEM4000® apparatus was 0.0mmol/L±0.8mmol/L. Between these two devices at lactate threshold of 4.8mmol/L, the negative predictive value was 96,2% (76/79) and the area under the curve was 0.98 (95% CI 0.96–1]. The mean difference between StatStrip Xpress and GEM4000® was 0.1mmol/L±0.7mmol/L. Between these two devices at the lactate threshold of 4.8mmol/L, the negative predictive value was 97,4% (76/78) and the area under the curve was 0.95 (95% CI 0.86–1). ConclusionThere is a good correlation between the lactates obtained by the reference device and the two portable devices Lactate Scout and StatStrip Xpress.

Umbilical cord arterial blood lactate dehydrogenase and pH as predictors of perinatal outcome in high-risk term pregnancies: A cohort study.

Birth asphyxia is a common cause of perinatal morbidity, mortality. To compare the efficacy of umbilical cord arterial blood lactate dehydrogenase (LDH) and pH as predictors of neonatal outcome in high-risk term pregnancies using receiver operating characteristic (ROC) curves. Present retrospective cohort study was conducted in the rural tertiary centre of Northern India over two years (January 2017-December 2018). Neonates delivered to 300 term (≥37 - ≤42 weeks) high-risk antenatal women were enrolled after fulfilling inclusion criteria. Immediately after delivery of a newborn by any mode, the segment of the umbilical cord (10 cm) was double clamped, cut, and arterial blood samples were taken for LDH and pH and were compared with neonatal outcome. Statistical analysis was done using SPSS 22.0 software. For all 300 neonates mean ± SD values of cord blood LDH and pH were 545.19 ± 391.93 U/L and 7.13 ± 0.15, respectively. High cord blood lactate and low pH values were significantly associated with adverse neonatal outcomes including neonatal resuscitation, NICU admission, complications and early neonatal deaths (p=0.000). The sensitivity, specificity and negative predictive value of cord blood LDH in the prediction of neonatal death was 100.00%, 53.17%, 100%, and pH was 93.75%, 53.17%, 99.34%, respectively. Cord blood lactate and pH help in the early prediction of neonatal outcomes, but cord blood lactate is a better predictor.

Umbilical Cord Blood Acid-Base Parameters and Lactate as Predictors of Subsequent Meconium Aspiration Syndrome in Neonates.

Meconium aspiration syndrome (MAS) in neonates born through meconium-stained amniotic fluid (MSAF) causes significant morbidity and mortality. Early recognition of at-risk neonates could help optimize treatment. The aim was to determine predictive characteristics of cord blood pH, base deficit and lactate with subsequent MAS. Receiver operating characteristic (ROC) curves with area under curve (AUC) were estimated. Among 231 MSAF complicated pregnancies, 25 (10.8%) had MAS. Mean cord pH was significantly lower in neonates with MAS compared to those without MAS (7.15 ± 0.11 vs. 7.26 ± 0.07; p < 0.001). Median lactate between the two groups [5.6 (7.5, 3.7) vs. 2.7 (4.5, 2.0)] and base deficit [-10.6 (-13.2, -4.2) vs. -3.7 (-6.3, -2.6)] also differed significantly (p = 0.01). ROC curve area for cord lactate, pH, and base deficit were 0.81, 0.79, and 0.75, respectively. The predictive cutoff values for pH, lactate, and base deficit were 7.20, 3.55mmol/L, and -5.3mmol/L, respectively.

Association of umbilical cord blood gas values with mortality and severe neurologic injury in preterm neonates

Umbilical cord arterial and venous blood gas values reflect the acid-base balance status of a newborn at birth. Derangement in these values has been linked to poor neonatal outcomes in term and late preterm neonates; however, the utility of these values in preterm neonates of <29 weeks' gestation is unclear. This study aimed to determine the associations of umbilical cord arterial and venous blood gas values with neonatal mortality and severe neurologic injury in extremely preterm neonates and to identify the cutoff values associated with 2.5-fold increases or decreases in the posttest probabilities of outcomes. This was a retrospective cohort study of neonates who were born at 23+0 to 28+6 weeks' gestation between January 1, 2018 and December 31, 2019, and who were admitted to neonatal units in Canada. Various cut-offs of umbilical cord blood gas values and lactate values were studied. The main outcomes were mortality before discharge from the neonatal unit and severe neurologic injury defined as grade 3 or 4 periventricular or intraventricular hemorrhage or periventricular leukomalacia. The outcome rates were calculated for various cutoff values of umbilical cord blood gas parameters and were adjusted for birthweight, gestational age, sex, and multiple births. Likelihood ratios were calculated to derive posttest probabilities. A total of 1040 and 1217 neonates had analyzable umbilical cord arterial and venous blood gas values, respectively. In the cohort, the mean (standard deviation) gestational age was 26.5 (1.5) weeks, the mean birthweight was 936 (215) g, the prevalence of mortality was 10% (105/1040), and the prevalence of severe neurologic injury was 9% (92/1016). An umbilical cord arterial pH of ≤7.1 and base excess of ≤-12 mmol/L were associated with >2.5-fold higher posttest probability of mortality, and an umbilical cord arterial or venous lactate value of <3 was associated with a 2.5-fold lower posttest probability of mortality. An umbilical cord arterial lactate value of <3 was associated with a lower posttest probability of severe neurological injury. In preterm neonates of <29 weeks' gestation, low umbilical cord arterial pH and high umbilical cord arterial base excess values were associated with a clinically important increase in the posttest probability of mortality, whereas low umbilical cord arterial or venous lactate values were associated with a decrease in the posttest probability of mortality.

Calcium and lactate in the fetal-to-neonatal transition

Objective To explore the relationship between calcium and lactate in arterial cord blood of healthy term neonates in response to the stress of labor. Methods This was a prospective cohort study of consecutive, vaginal, term births in a community medical center (April 2029 to February 2020). Calcium and lactate were measured in cord blood gas analysis immediately after delivery. Results In the arterial cord blood of 480 neonates, calcium levels were 1.5 (1.4; 1.5) mmol/L and lactate levels were 3.8 (2.9; 4.9) mmol/L. Calcium and lactate showed a statistically significant positive correlation (Pearson’s correlation, r = 0.15, p = .001). Calcium levels had a significant positive correlation with PaCO2 and a significant negative correlation with pH, PaO2, HCO3 −, and ABE levels. Multivariable analysis models confirmed that calcium levels were associated with HCO3 −, gestational age, and birth weight, all accounting for 7% of the variability. Conclusion In healthy term vaginally delivered neonates, it was found that calcium and lactate were strongly correlated, together pointing to a neonatal response to the stress of labor and delivery. Cord blood calcium regulation may have an ancillary role in defining neonatal adaptation to extrauterine life.

Effect of pre-operative bicarbonate infusion on maternal and perinatal outcomes among women with obstructed labour in Mbale hospital: A double blind randomized controlled trial.

Oral bicarbonate solution is known to improve both maternal and perinatal outcomes among women with abnormal labour (dystocia). Its effectiveness and safety among women with obstructed labour is not known. To determine the effect and safety of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal blood lactate and clinical outcomes among women with obstructed labour (OL) in Mbale hospital. We conducted a double blind, randomised controlled trial from July 2018 to September 2019. The participants were women with OL at term (≥37 weeks gestation), carrying a singleton pregnancy with no other obstetric emergency, medical comorbidity or laboratory derangements. A total of 477 women with OL were randomized to receive 50ml of 8.4% sodium bicarbonate (238 women) or 50 mL of 0.9% sodium chloride (239 women). In both the intervention and controls arms, each participant was preoperatively given a single dose intravenous bolus. Every participant received 1.5 L of normal saline in one hour as part of standard preoperative care. Our primary outcome was the mean difference in maternal venous blood lactate at one hour between the two arms. The secondary outcomes were umbilical cord blood lactate levels at birth, neonatal sepsis and early neonatal death upto 7 days postnatal, as well as the side effects of sodium bicarbonate, primary postpartum hemorrhage, maternal sepsis and mortality at 14 days postpartum. The median maternal venous lactate was 6.4 (IQR 3.3-12.3) in the intervention and 7.5 (IQR 4.0-15.8) in the control group, with a statistically non-significant median difference of 1.2 mmol/L; p-value = 0.087. Vargha and Delaney effect size was 0.46 (95% CI 0.40-0.51) implying very little if any effect at all. The 4.2g of preoperative intravenous sodium bicarbonate was safe but made little or no difference on blood lactate levels. PACTR201805003364421.

Evaluation of umbilical cord arterial blood gas analysis in gestational diabetes mellitus

Gestational diabetes mellitus (GDM) represents glucose levels in the high end of the population distribution during pregnancy. GDM carries a high risk of adverse outcomes such as perinatal outcomes and a longer-term risk of obesity and glucose intolerance in offspring. Mothers with GDM have an excess of hypertensive disorders during pregnancy and a high risk of diabetes mellitus after that. This study aimed to evaluatethe influence of hypoxia status, haematological parameters, cord blood lactate, and birth weight of infants on GDM and its complications. The study was conducted on 100 pregnant women having Gestational Diabetes Mellitus (GDM), and the control population consists of 50 normal pregnancies. Samples included in this study were foetal cord blood and maternal blood. Parameters such as blood gases, lactate, haemoglobin, RBC count, red cell indices, and fetal birth weight were determined. No suggestive changes were found in pH of GDM neonates when compared to the healthy foetus.GDM offspring, when compared to the normal, showed a significant decrease in pO2 and pCO2.A relative reduction in O2saturation and O2 content in GDM foetus when compared to a healthyfoetus. Lactate level is significantly increased in GDM neonates when correlated to the control group. There is a striking change in haemoglobin, RBC count, total WBC count, MCV and MCH in GDM. The results also suggest a correlation of cord blood Hb, cord blood PCV and Cord blood pO2 with the birth weight of infants. Lower oxygen saturation and oxygen content and increased lactate concentrations in offspring of GDM mothers indeed emulate intensified fetal metabolism as an outcome of hyperglycaemia and hyperinsulinemia, and therefore these fetuses demandconstant supervision at term and during delivery. Keywords: Gestational diabetes mellitus, Umbilical arterial cord blood, Hypoxic-ischemic event.

Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia.

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.

Correlation of Cord Lactate with Cord pH as a Morbidity Predictor in Term Neonates Delivered with Non-Reassuring Fetal Heart Status

Background: Perinatal asphyxia is accounting to 20% of neonatal mortalityin India. Cord lactate can be an alternative that is more readily available than cord pH and may help in early identification of birth asphyxia in resource limited settings. The aim of the current study is to correlate cord lactate levels with cord pH in term neonates with non-reassuring fetal heart status and thereby its use as a surrogate for cord pH. Subjects &amp; Methods: Study design: Cross-sectional study. Setting: Neonatology unit at NRI general hospital, Chinakakani from August 2018 to July 2019. Study participants: All singleton term neonates delivered by assisted vaginal delivery or emergency caesarean section due to non-reassuring fetal heart status. Umbilical cord blood gas and lactate was obtained. Lactate was analysed by colorimetric method. Results: A total of 74 neonates were included. An analysis of cord pH &amp; lactate, using correlation coefficient showed statistically significant p-values. Cord lactate was found to be statistically significant predictor for admission to NICU, post resuscitation care, invasive/noninvasive ventilation, and therapeutic hypothermia on multiple logistic regression analysis. Cord Lactate was found to have an Area under the curve (AUC) of 0.88 with no significant difference to cord pH on ROC curve analysis. Conclusion: Cord Lactate can be used as an objective test in predicting the neonates requiring NICU admission for morbidities related to fetal hypoxia similar to that of cord pH in term neonates.