title: Serum lactate dehydrogenase profile as a retrospective indicator of uterine preparedness for labor: a prospective, observational study.
abstract: BACKGROUND
  Lactate dehydrogenase (LDH) isoenzymes are required for adenosine triphosphate production, with each of five different isoenzymes having varying proficiencies in anaerobic versus aerobic environments. With advancing pregnancy, the isoenzyme profile in uterine muscle shifts toward a more anaerobic profile, speculatively to facilitate uterine efficiency during periods of low oxygen that accompany labor contractions. Profile shifting may even occur throughout labor. Maternal serum LDH levels between 24-48 hours following delivery predominantly originate from uterine muscle, reflecting the enzymatic state of the myometrium during labor. Our purpose was to describe serum LDH isoenzymes 24-30 hours post-delivery to determine if cervical dilation rates following labor admission were associated with a particular LDH profile. We also compared differences in post-delivery LDH isoenzyme profiles between women admitted in pre-active versus established active labor.
  
  
  METHODS
  Low-risk, nulliparous women with spontaneous labor onset were sampled (n = 91). Maternal serum LDH was measured at labor admission and 24-30 hours post-vaginal delivery. Rates of cervical dilation during the first four hours after admission were also measured. Spearman's rho coefficients were used for association testing and t tests evaluated for group and paired-sample differences.
  
  
  RESULTS
  More efficient dilation following admission was associated with decreased LDH1 (p = 0.029) and increased LDH3 and LDH4 (p = 0.017 and p = 0.017, respectively) in the post-delivery period. Women admitted in established active labor had higher relative serum levels of LDH3 (t = 2.373; p = 0.023) and LDH4 (t = 2.268; p = 0.029) and lower levels of LDH1 (t = 2.073; p = 0.045) and LDH5 (t = 2.041; p = 0.048) when compared to women admitted in pre-active labor.Despite having similar dilatations at admission (3.4 ± 0.5 and 3.7 ± 0.6 cm, respectively), women admitted in pre-active labor had longer in-hospital labor durations (12.1 ± 4.3 vs. 5.3 ± 1.4 hours; p < 0.001) and were more likely to receive oxytocin augmentation (95.5% vs. 34.8%; p < 0.001).
  
  
  CONCLUSIONS
  More efficient cervical dilation following labor admission is associated with a more anaerobic maternal serum LDH profile in the post-delivery period. Since LDH profile shifting may occur throughout labor, watchful patience rather than intervention in earlier labor may allow LDH shifting within the uterus to more fully manifest. This may improve uterine efficiency during labor and decrease rates of oxytocin augmentation, thereby improving birth safety.
authors.affiliation: The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA. neal.167@osu.edu
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Neal
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Lowe
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Corwin
mesh_terms: D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000502:physiology*; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D007747:Labor Stage, First / Q000097:blood / Q000502:physiology; D007743:Labor, Obstetric / Q000097:blood* / Q000502:physiology*; D000080864:Lactate Dehydrogenase 5; D009215:Myometrium / Q000201:enzymology / Q000502:physiology*; D049590:Postpartum Period / Q000097:blood; D011247:Pregnancy / Q000097:blood / Q000502:physiology*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D055815:Young Adult
chemical_list: D007527:Isoenzymes; D007770:L-Lactate Dehydrogenase; C409676:lactate dehydrogenase 2; C409677:lactate dehydrogenase 3; C409678:lactate dehydrogenase 4; D000080864:Lactate Dehydrogenase 5; C409667:lactate dehydrogenase 1