Gestational age reference ranges for umbilical cord blood lactate: An external validation study of post‐date pregnancies

Abstract

A previous study published in 2008 by Wiberg et al demonstrated increasing umbilical cord blood lactate at delivery by gestational age in vigorous offspring (n = 10 169, gestational age 24-43 weeks). Based on these results the authors concluded that gestational age-independent umbilical cord lactate cutoff could give false-negative or false-positive diagnosis of lacticemia. To our knowledge, these findings have not been incorporated into clinical interpretations in delivery units. To perform an external validity study for the findings by Wiberg et al, we analyzed umbilical cord blood lactate levels according to gestational age in a postdate delivery study population at our large, tertiary obstetric unit. The parallel finding of our study to that of Wiberg et al highlights the importance of using available gestational age dependent reference ranges (eg as presented in Wiberg's publication), when interpreting umbilical cord blood lactate levels for fetal wellbeing. K E Y W O R D S blood gas analyses, gestational age, lactate, pregnancy, reference range, umbilical cord blood This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Umbilical arterial lactate levels after normal vaginal and elective cesarean delivery: The role of a longer active second stage most significant in high levels after vaginal delivery

“…Our results provide new and valuable information about the normal birth process, even though we cannot totally exclude the presence of subclinical or transient birth asphyxia in our dataset. In line with the results of previous studies, the duration of the active second stage of labor was the strong effector to the high lactate levels, 10,13 but we also confirmed the previously reported significant association between higher gestational age and increased umbilical lactate levels 14,15,18 . In addition, there were many other clinically significant factors in the analysis, which were related to high UA lactate levels.…”

“…previous studies, the duration of the active second stage of labor was the strong effector to the high lactate levels, 10,13 but we also confirmed the previously reported significant association between higher gestational age and increased umbilical lactate levels. 14,15,18 In addition, there were many other clinically significant factors in the analysis, which were related to high UA lactate levels. Some of these, such as first delivery and short stature of the mother, have been considered previously as important risk factors for high fetal or umbilical lactate levels, 16,19 but the duration of maternal intrapartum infection, and infertility are less-studied clinical variables in this context.…”

Reference Values for Umbilical Artery Lactate by Mode of Delivery and Gestational Age: A Retrospective Observational Study

“…Recently, it was argued that the definition of neonatal lactic acidosis should be based on gestational age-dependent values [9,21]. In this study, we outlined reference values for lactate by simplified and generally acknowledged gestational age groups and across modes of delivery thereby providing simple reference tables for clinical use.…”