基于新生儿结局的产时胎儿监护中胎儿头皮血乳酸的临界值：一项大型前瞻性观察研究。
Proposed cutoff for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a large prospective observational study.
机构信息
Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Department of Obstetrics and Gynaecology, Helsingborg Hospital, Helsingborg, Sweden.
出版信息
BJOG. 2022 Mar;129(4):636-646. doi: 10.1111/1471-0528.16924. Epub 2021 Oct 4.
OBJECTIVE
Determination of lactate in fetal scalp blood (FBS) during labour has been recognised since the 1970s. The internationally accepted cutoff of >4.8 mmol/l indicating fetal acidosis is exclusive for the point-of-care device (POC) LactatePro™, which is no longer in production. The aim of this study was to establish a new cutoff for scalp lactate based on neonatal outcomes with the use of the StatstripLactate /StatstripXpress Lactate system, the only POC designed for hospital use.
DESIGN
Observational study.
SETTING
January 2016 to March 2020 labouring women with indication for FBS were prospectively included from seven Swedish and one Australian delivery unit.
POPULATION
Inclusion criteria: singleton pregnancy, vertex presentation, ≥35 weeks of gestation.
METHOD
Based on the optimal correlation between FBS lactate and cord pH/lactate, only cases with ≤25 minutes from FBS to delivery were included in the final calculations.
MAIN OUTCOME MEASURES
Metabolic acidosis in cord blood defined as pH <7.05 plus BD >10 mmol/l and/or lactate >10 mmol/l.
RESULTS
A total of 3334 women were enrolled of whom 799 were delivered within 25 minutes. The areas under the receiver operating characteristics curves (AUC) and corresponding optimal cutoff values were as follows; metabolic acidosis AUC 0.87 (95% CI 0.77-0.97), cutoff 5.7 mmol/l; pH <7.0 AUC 0.83 (95% CI 0.68-0.97), cutoff 4.6 mmol/l; pH <7.05 plus BD ≥12 mmol/l AUC 0.97 (95% CI 0.92-1), cutoff 5.8 mmol/l; Apgar score <7 at 5 minutes AUC 0.74 (95% CI 0.63-0.86), cutoff 5.2 mmol/l; and pH <7.10 plus composite neonatal outcome AUC 0.76 (95% CI 0.67-0.85), cutoff 4.8 mmol/l.
CONCLUSION
A scalp lactate level <5.2 mmol/l using the StatstripLactate /StatstripXpress system will safely rule out fetal metabolic acidosis.
TWEETABLE ABSTRACT
Scalp blood lactate <5.2 mmol/l using the StatstripLactate /StatstripXpress system has an excellent ability to rule out fetal acidosis.
目的
自 20 世纪 70 年代以来，人们一直认识到在分娩过程中检测胎儿头皮血（FBS）中的乳酸。国际上接受的>4.8mmol/l 表明胎儿酸中毒的截断值仅适用于已停产的即时检测设备（POC）LactatePro™。本研究的目的是基于新生儿结局，使用 StatstripLactate/StatstripXpress Lactate 系统建立新的头皮乳酸截断值，该系统是唯一专为医院使用而设计的 POC。
设计
观察性研究。
地点
2016 年 1 月至 2020 年 3 月，7 家瑞典和 1 家澳大利亚分娩单位有指征进行 FBS 的产妇前瞻性纳入研究。
人群
纳入标准：单胎妊娠、头位、≥35 孕周。
方法
根据 FBS 乳酸与脐血 pH/乳酸的最佳相关性，仅纳入 FBS 至分娩时间≤25 分钟的病例进行最终计算。
主要观察指标
定义为 pH<7.05 加 BD>10mmol/l 和/或乳酸>10mmol/l 的脐血代谢性酸中毒。
结果
共纳入 3334 名女性，其中 799 名在 25 分钟内分娩。受试者工作特征曲线（ROC）下面积（AUC）及其相应的最佳截断值如下：代谢性酸中毒 AUC 0.87（95%CI 0.77-0.97），截断值 5.7mmol/l；pH<7.0 AUC 0.83（95%CI 0.68-0.97），截断值 4.6mmol/l；pH<7.05 加 BD≥12mmol/l AUC 0.97（95%CI 0.92-1），截断值 5.8mmol/l；5 分钟时 Apgar 评分<7 AUC 0.74（95%CI 0.63-0.86），截断值 5.2mmol/l；pH<7.10 加复合新生儿结局 AUC 0.76（95%CI 0.67-0.85），截断值 4.8mmol/l。
结论
使用 StatstripLactate/StatstripXpress 系统，头皮血乳酸水平<5.2mmol/l 可安全排除胎儿代谢性酸中毒。
推特摘要
使用 StatstripLactate/StatstripXpress 系统，头皮血乳酸<5.2mmol/l 可极好地排除胎儿酸中毒。
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