Comparing fetal scalp lactate and umbilical cord arterial blood gas values.
BACKGROUND
Fetal scalp lactate has been shown to be as effective as scalp pH in predicting fetal outcomes. However, there is limited clinical evidence to demonstrate a strong correlation with fetal acidaemia at birth.


OBJECTIVE
To compare the diagnostic accuracy of fetal scalp lactate and umbilical cord arterial blood gas values sampling, as it is used in clinical practice.


METHODS
A retrospective cohort study was performed on 661 term (≥37 weeks) births where a fetal scalp lactate sample was taken during labour. Cases were excluded where either the lactate was taken greater than 1 h prior to delivery, incomplete cord gas analyses were available, or a sentinel hypoxic event occurred prior to delivery. The final data set included 229 microvolume scalp lactate measurements which were compared with neonatal paired cord blood gas values taken at delivery.


RESULTS
A fetal scalp lactate measurement of ≥4.8 mmol/L had a positive predictive value (PPV) of 1% and a negative predictive value (NPV) of 100% in predicting umbilical artery pH ≤7.00, and a PPV of 5% and a NPV of 98% in predicting umbilical artery pH ≤7.10. The sensitivity and specificity for these values were 100%, 23% and 90%, 23%, respectively.


CONCLUSIONS
Fetal scalp lactate microsampling has a strong negative predictive value for fetal acidaemia at birth.
Department of Obstetrics and Gynaecology, Mater Services, Brisbane, Australia.
Thea
T
Bowler
Michael
M
Beckmann
D000138:Acidosis / Q000175:diagnosis*; D001784:Blood Gas Analysis; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D005323:Fetal Monitoring; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007743:Labor, Obstetric; D019344:Lactic Acid / Q000032:analysis*; D011247:Pregnancy; D012189:Retrospective Studies; D012535:Scalp / Q000737:chemistry*; D012680:Sensitivity and Specificity
D019344:Lactic Acid
abnormal fetal heart rate; fetal acidaemia; fetal scalp blood microsampling; labour; lactate; metabolic acidosis