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Elevated umbilical cord arterial lactate at birth and electronic fetal monitoring characteristics on admission and in the active phase

Journal of Perinatology volume 39, pages 481–487 (2019)Cite this article

Subjects

Abstract

Objective

To investigate the association between elevated umbilical arterial lactate at birth and electronic fetal monitoring (EFM) characteristics at admission and in the beginning of the active phase of labor.

Study design

Nested case-control study within a prospective cohort of laboring patients at term who achieved active labor. Neonates with umbilical arterial lactate ≥ 4 mmol/L (cases, n = 119), were matched 1:1 to controls with lactate < 4 mmol/L. EFM patterns were compared with multivariable logistic regression.

Result

There were no differences in EFM parameters in the first 60 minutes after admission. At the beginning of active labor, 13.5% of cases and 26.1% of controls had always category I tracings, adjusted odds ratio 0.48, 95% confidence interval 0.24–0.94). Cases were less likely to have an always category I tracing from admission into the active phase.

Conclusion

Elevated umbilical arterial lactate at birth is associated with distinct EFM patterns early in the labor course.

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References

  1. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 106: intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol. 2009;114:192–202.

    Article  Google Scholar 

  2. Cahill AG, Tuuli MG, Stout MJ, Lopez JD, Macones GA. A prospective cohort study of fetal heart rate monitoring: deceleration area is predictive of fetal acidemia. Am J Obstet Gynecol. 2018;218:523.e1–523. e12.

    Article  Google Scholar 

  3. Cahill AG, Roehl KA, Odibo AO, Macones GA. Association and prediction of neonatal acidemia. Am J Obstet Gynecol. 2012;207:206 e1–8.

    Article  Google Scholar 

  4. Larma JD, Silva AM, Holcroft CJ, Thompson RE, Donohue PK, Graham EM. Intrapartum electronic fetal heart rate monitoring and the identification of metabolic acidosis and hypoxic-ischemic encephalopathy. Am J Obstet Gynecol. 2007;197:301 e1–8.

    Article  Google Scholar 

  5. Williams KP, Galerneau F. Intrapartum fetal heart rate patterns in the prediction of neonatal acidemia. Am J Obstet Gynecol. 2003;188:820–3.

    Article  Google Scholar 

  6. Vintzileos AM, Smulian JC. Decelerations, tachycardia, and decreased variability: have we overlooked the significance of longitudinal fetal heart rate changes for detecting intrapartum fetal hypoxia? Am J Obstet Gynecol. 2016;215:261–4.

    Article  Google Scholar 

  7. Tuuli MG, Stout MJ, Shanks A, Odibo AO, Macones GA, Cahill AG. Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term. Obstet Gynecol. 2014;124:756–61.

    Article  CAS  Google Scholar 

  8. Tuuli MG, Stout MJ, Macones GA, Cahill AG. Umbilical cord venous lactate for predicting arterial lactic acidemia and neonatal morbidity at term. Obstet Gynecol. 2016;127:674–80.

    Article  CAS  Google Scholar 

  9. Mires G, Williams F, Howie P. Randomised controlled trial of cardiotocography versus Doppler auscultation of fetal heart at admission in labour in low risk obstetric population. BMJ. 2001;322:1457–60.

    Article  CAS  Google Scholar 

  10. Devane D, Lalor JG, Daly S, McGuire W, Cuthbert A, Smith V. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. Cochrane Database Syst Rev. 2017;1:CD005122.

    PubMed  Google Scholar 

  11. Impey L, Reynolds M, MacQuillan K, Gates S, Murphy J, Sheil O. Admission cardiotocography: a randomised controlled trial. Lancet. 2003;361:465–70.

    Article  Google Scholar 

  12. Cahill AG, Spain J. Intrapartum fetal monitoring. Clin Obstet Gynecol. 2015;58:263–8.

    Article  Google Scholar 

  13. Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol. 2012;120:1181–93.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Presented in poster format at the 37th Annual Pregnancy Meeting, Society for Maternal-Fetal Medicine, 23–28 January 2017, Las Vegas, NV.

Author contributions

JIR: played an important role in interpreting the results, drafted the manuscript, approved the final version. MJS: played an important role in interpreting the results, revised the manuscript, approved the final version. MGT: played an important role in interpreting the results, revised the manuscript, approved the final version. JDL: acquired and analyzed data, played an important role in interpreting the results, revised the manuscript, approved the final version. GAM: conceived and designed the work that led to the submission, revised the manuscript, approved the final version. AGC: conceived and designed the work that led to the submission, acquired the data, played an important role in interpreting the results, revised the manuscript, approved the final version.

Funding

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01: HD 06161619-01A1, PI Cahill).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA

    Joshua I. Rosenbloom, Molly J. Stout, Methodius G. Tuuli, Julia D. López, George A. Macones & Alison G. Cahill

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  1. Joshua I. Rosenbloom
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  2. Molly J. Stout
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  3. Methodius G. Tuuli
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  4. Julia D. López
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  5. George A. Macones
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  6. Alison G. Cahill
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Corresponding author

Correspondence to Joshua I. Rosenbloom.

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The authors declare no competing interests.

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Rosenbloom, J.I., Stout, M.J., Tuuli, M.G. et al. Elevated umbilical cord arterial lactate at birth and electronic fetal monitoring characteristics on admission and in the active phase. J Perinatol 39, 481–487 (2019). https://doi.org/10.1038/s41372-019-0324-y

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