TY - JOUR
T1 - Fetal and maternal lactate increase during active second stage of labour
AU - Nordström, Lennart
AU - Achanna, Siva
AU - Naka, Keiichi
AU - Arulkumaran, Sabaratnam
PY - 2001
Y1 - 2001
N2 - Objective: To determine longitudinally fetal and maternal blood lactate concentrations during the second stage of labour. Design: Prospective, observational study of randomly selected labours. Setting: Labour ward, Sultanah Aminah General Hospital, Johore Bahru, Malaysia. Main outcome measures: Fetal scalp and maternal venous blood lactate, umbilical arterial and vein lactate and acid-base balance at delivery. Results: Sixty-nine women and their infants were monitored in the second stage of labour. Mean maternal venous lactate by the end of the first stage was 2.6 ± 10 (± S.D.) mmol/L and increased to 3.6 ± 1.4, 4.2 ± 1.7, 4.8 ± 1.6, 5.4 ± 2.1 and 4.3 ± 0.9 mmol/L, respectively, for every 15 minute of bearing down. Corresponding values for fetal scalp blood lactate were 2.4 ± 1.1, 3.1 ± 1.6, 3.2 ± 1.8, 4.2 ± 2.4, 4.9 ± 2.8 and 5.8 ± 1.9 mmol/L. The mean slope of maternal lactate increase was 0.070 mmol/L per minute (95% CI 0.050, 0.090) and for fetal lactate increase 0.032 mmol/L per minute (95% C.I.: 0.018, 0.045). The duration of active second stage was significantly associated with fetal lactate (P < 0.001) and maternal lactate (P = 0.03) at the time of crowning of the fetal head, and lactate in umbilical arterial and vein blood at delivery (P < 0.001). Expulsion time ≥ 45 minutes, compared with shorter active second stage, and acidaemia at birth implied larger arterial-venous lactate differences (P < 0.001). Fetal lactate at crowning was also significantly associated with the umbilical arterial-veonus lactate difference (P = 0.03). Conclusions: Maternal and fetal lactate concentrations increase significantly with duration of the active second stage of labour, more rapidly in the mother. It is likely that fetal anaerobic metabolism is the main source for the fetal lactate increase.
AB - Objective: To determine longitudinally fetal and maternal blood lactate concentrations during the second stage of labour. Design: Prospective, observational study of randomly selected labours. Setting: Labour ward, Sultanah Aminah General Hospital, Johore Bahru, Malaysia. Main outcome measures: Fetal scalp and maternal venous blood lactate, umbilical arterial and vein lactate and acid-base balance at delivery. Results: Sixty-nine women and their infants were monitored in the second stage of labour. Mean maternal venous lactate by the end of the first stage was 2.6 ± 10 (± S.D.) mmol/L and increased to 3.6 ± 1.4, 4.2 ± 1.7, 4.8 ± 1.6, 5.4 ± 2.1 and 4.3 ± 0.9 mmol/L, respectively, for every 15 minute of bearing down. Corresponding values for fetal scalp blood lactate were 2.4 ± 1.1, 3.1 ± 1.6, 3.2 ± 1.8, 4.2 ± 2.4, 4.9 ± 2.8 and 5.8 ± 1.9 mmol/L. The mean slope of maternal lactate increase was 0.070 mmol/L per minute (95% CI 0.050, 0.090) and for fetal lactate increase 0.032 mmol/L per minute (95% C.I.: 0.018, 0.045). The duration of active second stage was significantly associated with fetal lactate (P < 0.001) and maternal lactate (P = 0.03) at the time of crowning of the fetal head, and lactate in umbilical arterial and vein blood at delivery (P < 0.001). Expulsion time ≥ 45 minutes, compared with shorter active second stage, and acidaemia at birth implied larger arterial-venous lactate differences (P < 0.001). Fetal lactate at crowning was also significantly associated with the umbilical arterial-veonus lactate difference (P = 0.03). Conclusions: Maternal and fetal lactate concentrations increase significantly with duration of the active second stage of labour, more rapidly in the mother. It is likely that fetal anaerobic metabolism is the main source for the fetal lactate increase.
UR - http://www.scopus.com/inward/record.url?scp=0035090709&partnerID=8YFLogxK
U2 - 10.1016/S0306-5456(00)00034-6
DO - 10.1016/S0306-5456(00)00034-6
M3 - Article
C2 - 11281466
AN - SCOPUS:0035090709
SN - 0306-5456
VL - 108
SP - 263
EP - 268
JO - British Journal of Obstetrics and Gynaecology
JF - British Journal of Obstetrics and Gynaecology
IS - 3
ER -