title: The introduction of umbilical cord lactate measurement and associated neonatal outcomes in a South African tertiary hospital labor ward.
abstract: OBJECTIVE
  To investigate the utility of umbilical artery (UA) lactate measurements in a South African hospital for assessing intrapartum care and predicting neonatal outcomes.
  
  
  METHODS
  From 3 March-12 November 2014, we conducted a prospective cohort study of UA lactate levels at Kalafong Hospital, Pretoria, South Africa. Following birth, a UA blood sample (<0.5uL) was taken from a double-clamped segment of cord and the lactate measured. Maternal and neonatal characteristics and outcomes were recorded.
  
  
  RESULTS
  During the study, there were 4668 deliveries; including 1091 emergency cesarean and 154 instrumental deliveries. A lactate was recorded for 946 deliveries (20.3%). 190 babies required neonatal resuscitation, with an optimal cutoff for lactate of 5.45 mmol/L (sensitivity 68%, specificity 72%). 124 babies required nursery admission with the optimal cutoff for lactate 4.95 mmol/L (sensitivity 61%, specificity 59%). 55 babies had an Apgar score <7 at 5 min and the optimal lactate for this outcome was 5.65 mmol/L (sensitivity 64%, specificity of 69%).
  
  
  CONCLUSIONS
  Umbilical lactate can be used in a middle-low resource setting as a measurement of intrapartum hypoxia, with reasonable sensitivity and specificity for the prediction of, or need for, resuscitation, admission to the nursery, and low Apgar scores.
authors.affiliation: a Faculty of Medicine, Dentistry, and Health Sciences , School of Women's and Infants' Health, University of Western Australia , Crawley , Australia.|b SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology , University of Pretoria , Pretoria , South Africa.
authors.forename: E R
authors.initials: ER
authors.lastname: Allanson
authors.affiliation: b SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology , University of Pretoria , Pretoria , South Africa.
authors.forename: R C
authors.initials: RC
authors.lastname: Pattinson
authors.affiliation: a Faculty of Medicine, Dentistry, and Health Sciences , School of Women's and Infants' Health, University of Western Australia , Crawley , Australia.
authors.forename: E A
authors.initials: EA
authors.lastname: Nathan
authors.affiliation: a Faculty of Medicine, Dentistry, and Health Sciences , School of Women's and Infants' Health, University of Western Australia , Crawley , Australia.
authors.forename: J E
authors.identifier: http://orcid.org/0000-0003-3928-3290
authors.initials: JE
authors.lastname: Dickinson
mesh_terms: D000328:Adult; D001034:Apgar Score; D015415:Biomarkers / Q000097:blood; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D005311:Fetal Hypoxia / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D007363:Intensive Care Units, Neonatal; D019344:Lactic Acid / Q000097:blood*; D011247:Pregnancy; D011446:Prospective Studies; D012151:Resuscitation / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D013019:South Africa; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014470:Umbilical Cord; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: Lactate; South Africa; intrapartum; neonatal; resuscitation