title: Association between adverse neonatal outcome and lactate concentration in amniotic fluid.
abstract: OBJECTIVE
  To estimate whether a high lactate concentration in amniotic fluid, together with cardiotocography, can be used as an indicator for an increased risk of adverse neonatal outcome at delivery.
  
  
  METHODS
  A prospective cohort study was performed at two tertiary center labor wards in Sweden. Healthy women with full-term, singleton pregnancies and cephalic presentation in spontaneous active labor were included in the study (N=825). Lactate concentration in samples of amniotic fluid collected in the course of vaginal examinations during labor were correlated with cardiotocography 30 minutes before delivery and a composite score for adverse neonatal outcome.
  
  
  RESULTS
  High lactate concentration in amniotic fluid (greater than 10.1 mmol/L) was associated with an adverse neonatal outcome (odds ratio [OR] 4.4, 95% confidence interval [CI] 2.3-8.2). Fetal bradycardia within 30 minutes before delivery was also associated with an increased risk of adverse neonatal outcome (OR 7.4, 95% CI 3.04-18.11). If lactate in amniotic fluid was greater than 10.1 mmol/L and bradycardia was seen together, the risk of delivering a neonate with an adverse neonatal outcome was increased 11-fold (OR 10.7, 95% CI 3.7-31.7).
  
  
  CONCLUSIONS
  High lactate concentration in amniotic fluid and fetal bradycardia during the last 30 minutes before delivery indicate an increased risk of adverse neonatal outcome at delivery.
authors.affiliation: From the Department of Clinical Science and Education, Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital, Stockholm, Sweden; the Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; the Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institute, Danderyd Hospital, Danderyd, Sweden; the Department of Clinical Sciences and Education, Sachs Children's Hospital, Karolinska Institute, Soder Sjukhuset, Stockholm, Sweden; and the Department of Obstetrics and Gynecology, Sahlgrenska University Hospital East, Gothenburg, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Wiberg-Itzel
authors.forename: Helena
authors.initials: H
authors.lastname: Akerud
authors.forename: Ellika
authors.initials: E
authors.lastname: Andolf
authors.forename: Lena
authors.initials: L
authors.lastname: Hellström-Westas
authors.forename: Birger
authors.initials: B
authors.lastname: Winbladh
authors.forename: Ulla-Britt
authors.initials: UB
authors.lastname: Wennerholm
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000378:metabolism*; D001034:Apgar Score; D001919:Bradycardia / Q000453:epidemiology; D015148:Cardiotocography; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000378:metabolism / Q000502:physiology*; D007773:Lactates / Q000378:metabolism*; D016015:Logistic Models; D011247:Pregnancy; D011256:Pregnancy Outcome; D055815:Young Adult
chemical_list: D007773:Lactates