Prouhèze Audrey, Girault Aude, Barrois Mathilde, Lepercq Jacques, Goffinet François, Le Ray Camille
Maternity of Port-Royal, AP-HP. APHP., Paris University Center, FHU PREMA, Paris, France.
Maternity of Port-Royal, AP-HP. APHP., Paris University Center, FHU PREMA, Paris, France; Paris University, INSERM U1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research on Epidemiology and Statisctics Sorbonne Paris Cité (CRESS), Paris, France.
J Gynecol Obstet Hum Reprod. 2021 Apr;50(4):101964. doi: 10.1016/j.jogoh.2020.101964. Epub 2020 Oct 31.
Assess the discordance between scalp pH and lactates performed from the same sample during labor.
This single-center retrospective study included all women with a singleton fetus who had at least one fetal blood sample taken during labor. Some of them had up to seven samples. Scalp pH was the reference parameter for obstetric decision-making. The correlation between the pH and lactates was studied using Pearson coefficient. By categorizing the values as normal, pre-acidosis and acidosis, we were able to estimate agreement with Cohen's kappa coefficient. The frequency of discordance in the categorization and the factors related to it were studied with univariate and multivariable analyses. Cases of severe acidosis at birth (cord pH < 7.00) and cases with acidosis scalp lactates but normal scalp pH were analyzed.
We analyzed 480 samples from 268 fetuses among the 2644 deliveries during the study periode. Fetal blood sampling represented 10 % of deliveries. The scalp pH and lactates results were strongly correlated (r=-0.83), but their agreement was only fair (K = 0.36). In 29.4 % of cases, pH and lactates were discordant. Factors related to discordance were meconium-stained fluid, sampling at full dilation and multiple sampling. Six infants (2.2 %) had severe acidosis at birth. Cases' analyses did not allow to conclude severe acidosis could have been avoided using scalp lactates for obstetric decision-making.
For more than a quarter of the samples, results were discordant between scalp pH and lactates, especially when cervix was full dilated and when the amniotic fluid was meconium-stained. A randomized controlled trial comparing the relevance of each parameter according to the obstetrical situation would be necessary.
评估分娩期间同一样本的头皮pH值与乳酸值之间的不一致性。
这项单中心回顾性研究纳入了所有单胎妊娠且在分娩期间至少采集了一份胎儿血样的女性。其中一些女性有多达七份样本。头皮pH值是产科决策的参考参数。使用Pearson系数研究pH值与乳酸值之间的相关性。通过将数值分类为正常、酸中毒前期和酸中毒，我们能够用Cohen's kappa系数估计一致性。采用单因素和多因素分析研究分类中不一致的频率及其相关因素。分析出生时严重酸中毒（脐动脉血pH值＜7.00）的病例以及头皮乳酸值显示酸中毒但头皮pH值正常的病例。
在研究期间的2644例分娩中，我们分析了来自268例胎儿的480份样本。胎儿血样采集占分娩总数的10%。头皮pH值与乳酸值结果高度相关（r = -0.83），但它们的一致性仅为中等（K = 0.36）。在29.4%的病例中，pH值与乳酸值不一致。与不一致相关的因素有羊水粪染、宫口开全时采样以及多次采样。六名婴儿（2.2%）出生时患有严重酸中毒。病例分析无法得出使用头皮乳酸值进行产科决策可避免严重酸中毒的结论。
超过四分之一的样本中，头皮pH值与乳酸值结果不一致，尤其是在宫颈完全扩张且羊水粪染时。有必要进行一项随机对照试验，根据产科情况比较每个参数的相关性。
