From the Department of Clinical Science and Education, Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital, Stockholm, Sweden; the Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; the Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institute, Danderyd Hospital, Danderyd, Sweden; the Department of Clinical Sciences and Education, Sachs Children's Hospital, Karolinska Institute, Soder Sjukhuset, Stockholm, Sweden; and the Department of Obstetrics and Gynecology, Sahlgrenska University Hospital East, Gothenburg, Sweden.
Obstet Gynecol. 2011 Jul;118(1):135-142. doi: 10.1097/AOG.0b013e318220c0d4.
To estimate whether a high lactate concentration in amniotic fluid, together with cardiotocography, can be used as an indicator for an increased risk of adverse neonatal outcome at delivery.
A prospective cohort study was performed at two tertiary center labor wards in Sweden. Healthy women with full-term, singleton pregnancies and cephalic presentation in spontaneous active labor were included in the study (N=825). Lactate concentration in samples of amniotic fluid collected in the course of vaginal examinations during labor were correlated with cardiotocography 30 minutes before delivery and a composite score for adverse neonatal outcome.
High lactate concentration in amniotic fluid (greater than 10.1 mmol/L) was associated with an adverse neonatal outcome (odds ratio [OR] 4.4, 95% confidence interval [CI] 2.3-8.2). Fetal bradycardia within 30 minutes before delivery was also associated with an increased risk of adverse neonatal outcome (OR 7.4, 95% CI 3.04-18.11). If lactate in amniotic fluid was greater than 10.1 mmol/L and bradycardia was seen together, the risk of delivering a neonate with an adverse neonatal outcome was increased 11-fold (OR 10.7, 95% CI 3.7-31.7).
High lactate concentration in amniotic fluid and fetal bradycardia during the last 30 minutes before delivery indicate an increased risk of adverse neonatal outcome at delivery.
评估羊水乳酸浓度升高联合胎心监护图能否作为分娩时不良新生儿结局风险增加的指标。
在瑞典的两家三级中心产房进行了一项前瞻性队列研究。纳入研究的对象为足月、单胎、头位、自发性活跃期分娩的健康孕妇（N=825）。在分娩过程中进行阴道检查时采集羊水样本，检测其中的乳酸浓度，与分娩前 30 分钟的胎心监护图和不良新生儿结局综合评分相关联。
羊水乳酸浓度升高（大于 10.1mmol/L）与不良新生儿结局相关（比值比 [OR] 4.4，95%置信区间 [CI] 2.3-8.2）。分娩前 30 分钟内胎儿心动过缓也与不良新生儿结局风险增加相关（OR 7.4，95% CI 3.04-18.11）。如果羊水乳酸浓度大于 10.1mmol/L 且同时出现心动过缓，那么新生儿发生不良结局的风险增加 11 倍（OR 10.7，95% CI 3.7-31.7）。
分娩前最后 30 分钟内羊水乳酸浓度升高和胎儿心动过缓提示分娩时不良新生儿结局风险增加。
