Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace

East, Christine E., Leader, Leo R., Sheehan, Penelope, Henshall, Naomi E. and Colditz, Paul B. (2010) Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace. Cochrane Database of Systematic Reviews, 2010 3: CD006174-1-CD006174-30. doi:10.1002/14651858.CD006174.pub2

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Author East, Christine E.
Leader, Leo R.
Sheehan, Penelope
Henshall, Naomi E.
Colditz, Paul B.
Title Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2010
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD006174.pub2
Open Access Status File (Publisher version)
Volume 2010
Issue 3
Start page CD006174-1
End page CD006174-30
Total pages 30
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons Ltd.
Collection year 2011
Language eng
Subject 111401 Foetal Development and Medicine
920501 Child Health
Formatted abstract
BACKGROUND: Fetal blood sampling for lactate estimation may be considered following identification of an abnormal or non-reassuring fetal heart rate pattern. The smaller volume of blood required for this test, compared with the more traditional pH estimation, may improve sampling rates. The appropriate use of this practice mandates systematic review of its safety and clinical effectiveness prior to widespread introduction.
OBJECTIVES: To evaluate the effectiveness and risks of fetal scalp lactate sampling in the assessment of fetal well-being during labour, compared with no testing or alternative testing.
SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2009).
SELECTION CRITERIA
: All published and unpublished randomised and quasi-randomised trials that compared fetal scalp lactate testing with no testing or alternative testing to evaluate fetal status in the presence of a non-reassuring cardiotocograph during labour.
DATA COLLECTION AND ANALYSIS: Two review authors assessed the studies independently. MAIN RESULTS: The two identified randomised trials considered outcomes for 3348 mother-baby pairs allocated to either lactate or pH estimation of fetal blood samples in labour. There were no statistically significant differences for any fetal/neonatal/infant outcomes, including low Apgar score at five minutes, admission to neonatal intensive care units or neonatal encephalopathy, or for low umbilical arterial pH, base deficit or metabolic acidaemia. There was a statistically higher success rate for lactate compared with pH estimation (risk ratio 1.10, 95% confidence interval 1.08 to 1.12, n = 2992). There were no significant between-group differences in mode of birth or operative birth for non-reassuring fetal status. No studies reported outcomes of maternal satisfaction with fetal monitoring, anxiety, length of hospital stay or economic analysis.
AUTHORS' CONCLUSIONS: When further testing to assess fetal well-being in labour is indicated, fetal scalp blood lactate estimation is more likely to be successfully undertaken than pH estimation. Action cut-off lactate values need to consider the lactate meter used. Further studies may consider sub-group analysis by gestational age, the stage of labour and sampling within a prolonged second stage of labour. Additionally, future studies may address longer-term neonatal outcomes, maternal satisfaction with intrapartum fetal monitoring and an economic analysis. Copyright © 2010 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.
Keyword Fetal Development
Fetal Heart-rate
Fetal blood sampling
Fetal scalp lactate sampling
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article# CD006174, pp.1-30 Intervention Review Publication status and date: New, published in Issue 3, 2010. Review content assessed as up-to-date: 16 February 2010. Citation: East CE, Leader LR, Sheehan P, Henshall NE, Colditz PB. Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD006174. DOI: 10.1002/14651858.CD006174.pub2.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: UQ Centre for Clinical Research Publications
Official 2011 Collection
School of Medicine Publications
 
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Created: Sun, 04 Apr 2010, 00:06:24 EST