Wiberg-Itzel Eva, Wray Susan, Åkerud Helena
a Department of Obstetrics and Gynecology , Sodersjukhuset , Stockholm , Sweden.
b Department of Clinical Science and Education, Section of Obstetrics and Gynaecology , Karolinska Institutet , Sodersjukhuset , Sweden.
J Matern Fetal Neonatal Med. 2018 Sep;31(17):2237-2244. doi: 10.1080/14767058.2017.1339268. Epub 2017 Jun 22.
Labor dystocia is an intransigent, high-profile issue in obstetric care. Amniotic fluid lactate (AFL) reflects the uterine metabolic status. High levels associate with subsequent need for operative intervention due to dystocia. In sports medicine, it is known that lactic acid can affect muscular performance and can be decreased by bicarbonate given orally before physical activity.
Two hundred dystocic deliveries were included. At the confirmation of dystocia, the AFL-level was analyzed. Deliveries were randomized to an intake of bicarbonate or not. In the "non-bicarbonate-group", stimulation with oxytocin was started immediately. In the "bicarbonate-group", bicarbonate was given; and oxytocin was started 1 hour after the intake. New sampling of AF was performed after 1 hour in both groups.
if an oral intake of bicarbonate changes the AFL levels and enhances delivery outcome in dystocic deliveries.
Bicarbonate decreases the AFL levels (p < .001). The spontaneous vaginal delivery rate after treatment with bicarbonate was increased (p = .007), without affecting the fetal outcome.
An increase of spontaneous vaginal deliveries resulted from bicarbonate ingestion by dystocic women. A decreased level of AFL-level was shown. This simple, low cost treatment has the potential to improve maternal morbidity and satisfaction worldwide.
产力异常是产科护理中一个棘手且备受关注的问题。羊水乳酸（AFL）反映子宫代谢状态。高水平的AFL与随后因产力异常而需要手术干预相关。在运动医学中，已知乳酸会影响肌肉性能，并且在体育活动前口服碳酸氢盐可降低乳酸水平。
纳入200例产力异常的分娩病例。在确诊产力异常时，分析AFL水平。将分娩病例随机分为是否摄入碳酸氢盐两组。在“非碳酸氢盐组”，立即开始使用缩宫素刺激。在“碳酸氢盐组”，给予碳酸氢盐；摄入后1小时开始使用缩宫素。两组在1小时后均进行羊水新样本采集。
口服碳酸氢盐是否会改变产力异常分娩中的AFL水平并改善分娩结局。
碳酸氢盐可降低AFL水平（p < 0.001）。使用碳酸氢盐治疗后，自然阴道分娩率有所提高（p = 0.007），且不影响胎儿结局。
产力异常的女性摄入碳酸氢盐可提高自然阴道分娩率。AFL水平降低。这种简单、低成本的治疗方法有可能改善全球范围内的孕产妇发病率和满意度。
