Lactate concentration in amniotic fluid: a good predictor of labor outcome

Wiberg-Itzel, Eva; Pettersson, Hans; Andolf, Ellika; Hansson, Agneta; Winbladh, Birger; Åkerud, Helena

doi:10.1016/j.ejogrb.2010.05.005

« Previous Next »European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume 152, Issue 1 , Pages 34-38, September 2010

Lactate concentration in amniotic fluid: a good predictor of labor outcome

Eva Wiberg-Itzel
- Department of Clinical Science and Education, Section of Obstetrics and Gynaecology, Karolinska Institutet, SöderSjukhuset, Sweden
- Corresponding author at: Department of Obstetrics and Gynaecology, Soder Hospital, 118 83 Stockholm, Sweden. Tel.: +46 8 6163768.
Hans Pettersson
- Department of Clinical Science and Education, Section of Biostatistics, Karolinska Institutet, SöderSjukhuset, Sweden
Ellika Andolf
- Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Karolinska Institutet, Danderyd Hospital, Sweden
Agneta Hansson
- Karlstad Central Hospital, Sweden
Birger Winbladh
- Department of Clinical Sciences and Education, Sachs Children's Hospital, Karolinska Institute, SöderSjukhuset, Sweden
Helena Åkerud
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden

Received 26 November 2009; received in revised form 24 March 2010; accepted 13 May 2010. published online 31 May 2010.

Abstract

Objective

Previous publications have suggested that high levels of lactate in amniotic fluid (AF) correlate with dysfunctional labor. The aim of this study was to investigate whether lactate concentration in AF together with the partogram is a better predictor of operative intervention in dysfunctional labor than the partogram alone.

Study design

A prospective observational study was carried out of 825 laboring women. Samples of AF were collected and the lactate concentration was analyzed at the bedside during labor. The main outcome of the study was the method of delivery (operative/spontaneous vaginal) in relation to the concentration of lactate in AF. Logistic regression was used to estimate the association between lactate concentration in AF and labor outcome and to adjust for well-known risk factors for dysfunctional labor.

Results

385/825 women had an arrested labor according to the partogram, and 193 of them were delivered operatively. High lactate in AF (>10.1mmol/l) when labor arrested was associated with an increased risk of operative intervention due to dysfunctional labor (adjusted OR, 5.4, 95% CI, 3.2–9.1). Low levels of lactate in AF (<10.1mmol/l) were associated with an increased probability of spontaneous vaginal delivery (adjusted OR, 2.7, 95% CI, 1.7–4.8).

Conclusion

The partogram together with the concentration of lactate in AF is a better predictor of operative intervention in dysfunctional labor than the partogram alone.

Keywords: Lactate in AF, Dysfunctional labor, Partogram, Operative delivery