title: Lactate in Amniotic Fluid: Predictor of Labor Outcome in Oxytocin-Augmented Primiparas' Deliveries.
abstract: BACKGROUND
  One of the major complications related to delivery is labor dystocia, or an arrested labor progress. Many dystocic deliveries end vaginally after administration of oxytocin, but a large numbers of women with labor dystocia will undergo a long and unsafe parturition. As a result of the exertion required in labor, the uterus produces lactate. The uterine production of lactate is mirrored by the level of lactate in amniotic fluid (AFL).
  
  
  OBJECTIVE
  To evaluate whether the level of AFL, analysed in a sample of amniotic fluid collected vaginally at arrested labor when oxytocin was needed, could predict labor outcome in nulliparous deliveries.
  
  
  METHODS
  A prospective multicentre study including 3000 healthy primiparous women all with a singleton pregnancy, gestational age 37 to 42 weeks and no maternal /fetal chronic and/or pregnancy-related conditions. A spontaneous onset of labor, regular contractions and cervical dilation ≥ 3 cm were required before the women were invited to take part in the study.
  
  
  RESULTS
  AFL, analysed within 30 minutes before augmentation, provides information about delivery outcome. Sensitivity for an acute cesarean section according to high (≥10.1mmol/l) or low (< 10.1mmol/l) AFL values was 39.0% (95% CI; 27-50), specificity 90.3% (95% CI; 87-93) PPV 37.3% (95% CI; 27-48) and NPV was 91.0% (95% CI; 88-93). The overall percentage of correct predictions of delivery outcome when the AFL level was used was 83.7%. Deliveries with a high AFL-level correlated with delivery time >12h (p = 0.04), post-partum fever (>38°C, p = 0.01) and post-partum haemorrhage >1.5L (p = 0.04).
  
  
  CONCLUSIONS
  The AFL is a good predictor of delivery outcome in arrested nulliparous deliveries. Low levels of AFL may support the decision to continue a prolonged vaginal labor by augmentation with oxytocin. A high level of AFL correlates with operative interventions and post-partum complications.
authors: Department of Clinical Science and Education, Karolinska Institute, Soder Hospital, Stockholm, Sweden.
authors: Eva
authors: http://orcid.org/0000-0002-4835-9616
authors: E
authors: Wiberg-Itzel
authors: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors: Andrea B
authors: AB
authors: Pembe
authors: Department of Clinical Science and Education, Karolinska Institute, Soder Hospital, Stockholm, Sweden.
authors: Hans
authors: H
authors: Järnbert-Pettersson
authors: Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
authors: Margareta
authors: M
authors: Norman
authors: Umea University, Umea, Sweden.
authors: Anna-Carin
authors: AC
authors: Wihlbäck
authors: University of Basel, Basel, Switzerland.
authors: Irene
authors: I
authors: Hoesli
authors: Kantonsspital, Aarau, Switzerland.
authors: Monya
authors: M
authors: Todesco Bernasconi
authors: Hospital Bichat Claude Bernard, Paris, France.
authors: Elie
authors: E
authors: Azria
authors: KBH, Uppsala University, Uppsala, Sweden.
authors: Helena
authors: H
authors: Åkerud
authors: KBH, Uppsala University, Uppsala, Sweden.|Norwegian University of Sciences and Technology, Trondheim, Norway.
authors: Elisabet
authors: E
authors: Darj
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000378:metabolism*; D002585:Cesarean Section; D004420:Dystocia / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007743:Labor, Obstetric / Q000187:drug effects*; D019344:Lactic Acid / Q000032:analysis*; D008423:Maternal Age; D016017:Odds Ratio; D010120:Oxytocics / Q000494:pharmacology* / Q000627:therapeutic use; D010121:Oxytocin / Q000494:pharmacology* / Q000627:therapeutic use; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D010120:Oxytocics; D019344:Lactic Acid; D010121:Oxytocin