Cargando…

Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial

BACKGROUND: In high resource settings, lactate and pH levels measured from fetal scalp and umbilical cord blood are widely used as predictors of perinatal mortality. However, the same is not true in low resource settings, where much of perinatal mortality occurs. The scalability of this practice has...

Descripción completa

Detalles Bibliográficos
Autores principales: Musaba, Milton W., Nambozo, Brendah, Mukunya, David, Wandabwa, Julius, Barageine, Justus K., Kiondo, Paul, Napyo, Agnes, Sserwanja, Quraish, Weeks, Andrew D, Tumwine, James K, Ndeezi, Grace
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10111771/
https://www.ncbi.nlm.nih.gov/pubmed/37072754
http://dx.doi.org/10.1186/s12887-023-04008-y
_version_ 1785027514861617152
author Musaba, Milton W.
Nambozo, Brendah
Mukunya, David
Wandabwa, Julius
Barageine, Justus K.
Kiondo, Paul
Napyo, Agnes
Sserwanja, Quraish
Weeks, Andrew D
Tumwine, James K
Ndeezi, Grace
author_facet Musaba, Milton W.
Nambozo, Brendah
Mukunya, David
Wandabwa, Julius
Barageine, Justus K.
Kiondo, Paul
Napyo, Agnes
Sserwanja, Quraish
Weeks, Andrew D
Tumwine, James K
Ndeezi, Grace
author_sort Musaba, Milton W.
collection PubMed
description BACKGROUND: In high resource settings, lactate and pH levels measured from fetal scalp and umbilical cord blood are widely used as predictors of perinatal mortality. However, the same is not true in low resource settings, where much of perinatal mortality occurs. The scalability of this practice has been hindered by difficulty in collecting fetal scalp and umbilical blood sample. Little is known about the use of alternatives such as maternal blood, which is easier and safer to obtain. Therefore, we aimed to compare maternal and umbilical cord blood lactate levels for predicting perinatal deaths. METHODS: This was secondary analysis of data from a randomized controlled trial assessing the effect of sodium bicarbonate on maternal and perinatal outcomes among women with obstructed labour at Mbale regional referral hospital in Eastern Uganda. Lactate concentration in maternal capillary, myometrial, umbilical venous and arterial blood was measured at the bedside using a lactate Pro 2 device (Akray, Japan Shiga) upon diagnosis of obstructed labour. We constructed Receiver Operating Characteristic curves to compare the predictive ability of maternal and umbilical cord lactate and the optimal cutoffs calculated basing on the maximal Youden and Liu indices. RESULTS: Perinatal mortality risk was: 102.2 deaths per 1,000 live births: 95% CI (78.1–130.6). The areas under the ROC curves were 0.86 for umbilical arterial lactate, 0.71 for umbilical venous lactate, and 0.65 for myometrial lactate, 0.59 for maternal lactate baseline, and 0.65 at1hr after administration of bicarbonate. The optimal cutoffs for predicting perinatal death were 15 0.85 mmol/L for umbilical arterial lactate, 10.15mmol/L for umbilical venous lactate, 8.75mmol/L for myometrial lactate, and 3.95mmol/L for maternal lactate at recruitment and 7.35mmol/L after 1 h. CONCLUSION: Maternal lactate was a poor predictor of perinatal death, but umbilical artery lactate has a high predictive value. There is need for future studies on the utility of amniotic fluid in predicting intrapartum perinatal deaths.
format Online
Article
Text
id pubmed-10111771
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-101117712023-04-19 Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial Musaba, Milton W. Nambozo, Brendah Mukunya, David Wandabwa, Julius Barageine, Justus K. Kiondo, Paul Napyo, Agnes Sserwanja, Quraish Weeks, Andrew D Tumwine, James K Ndeezi, Grace BMC Pediatr Research BACKGROUND: In high resource settings, lactate and pH levels measured from fetal scalp and umbilical cord blood are widely used as predictors of perinatal mortality. However, the same is not true in low resource settings, where much of perinatal mortality occurs. The scalability of this practice has been hindered by difficulty in collecting fetal scalp and umbilical blood sample. Little is known about the use of alternatives such as maternal blood, which is easier and safer to obtain. Therefore, we aimed to compare maternal and umbilical cord blood lactate levels for predicting perinatal deaths. METHODS: This was secondary analysis of data from a randomized controlled trial assessing the effect of sodium bicarbonate on maternal and perinatal outcomes among women with obstructed labour at Mbale regional referral hospital in Eastern Uganda. Lactate concentration in maternal capillary, myometrial, umbilical venous and arterial blood was measured at the bedside using a lactate Pro 2 device (Akray, Japan Shiga) upon diagnosis of obstructed labour. We constructed Receiver Operating Characteristic curves to compare the predictive ability of maternal and umbilical cord lactate and the optimal cutoffs calculated basing on the maximal Youden and Liu indices. RESULTS: Perinatal mortality risk was: 102.2 deaths per 1,000 live births: 95% CI (78.1–130.6). The areas under the ROC curves were 0.86 for umbilical arterial lactate, 0.71 for umbilical venous lactate, and 0.65 for myometrial lactate, 0.59 for maternal lactate baseline, and 0.65 at1hr after administration of bicarbonate. The optimal cutoffs for predicting perinatal death were 15 0.85 mmol/L for umbilical arterial lactate, 10.15mmol/L for umbilical venous lactate, 8.75mmol/L for myometrial lactate, and 3.95mmol/L for maternal lactate at recruitment and 7.35mmol/L after 1 h. CONCLUSION: Maternal lactate was a poor predictor of perinatal death, but umbilical artery lactate has a high predictive value. There is need for future studies on the utility of amniotic fluid in predicting intrapartum perinatal deaths. BioMed Central 2023-04-18 /pmc/articles/PMC10111771/ /pubmed/37072754 http://dx.doi.org/10.1186/s12887-023-04008-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Musaba, Milton W.
Nambozo, Brendah
Mukunya, David
Wandabwa, Julius
Barageine, Justus K.
Kiondo, Paul
Napyo, Agnes
Sserwanja, Quraish
Weeks, Andrew D
Tumwine, James K
Ndeezi, Grace
Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial
title Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial
title_full Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial
title_fullStr Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial
title_full_unstemmed Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial
title_short Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial
title_sort maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10111771/
https://www.ncbi.nlm.nih.gov/pubmed/37072754
http://dx.doi.org/10.1186/s12887-023-04008-y
work_keys_str_mv AT musabamiltonw maternalandumbilicalcordbloodlactateforpredictingperinataldeathasecondaryanalysisofdatafromarandomizedcontrolledtrial
AT nambozobrendah maternalandumbilicalcordbloodlactateforpredictingperinataldeathasecondaryanalysisofdatafromarandomizedcontrolledtrial
AT mukunyadavid maternalandumbilicalcordbloodlactateforpredictingperinataldeathasecondaryanalysisofdatafromarandomizedcontrolledtrial
AT wandabwajulius maternalandumbilicalcordbloodlactateforpredictingperinataldeathasecondaryanalysisofdatafromarandomizedcontrolledtrial
AT barageinejustusk maternalandumbilicalcordbloodlactateforpredictingperinataldeathasecondaryanalysisofdatafromarandomizedcontrolledtrial
AT kiondopaul maternalandumbilicalcordbloodlactateforpredictingperinataldeathasecondaryanalysisofdatafromarandomizedcontrolledtrial
AT napyoagnes maternalandumbilicalcordbloodlactateforpredictingperinataldeathasecondaryanalysisofdatafromarandomizedcontrolledtrial
AT sserwanjaquraish maternalandumbilicalcordbloodlactateforpredictingperinataldeathasecondaryanalysisofdatafromarandomizedcontrolledtrial
AT weeksandrewd maternalandumbilicalcordbloodlactateforpredictingperinataldeathasecondaryanalysisofdatafromarandomizedcontrolledtrial
AT tumwinejamesk maternalandumbilicalcordbloodlactateforpredictingperinataldeathasecondaryanalysisofdatafromarandomizedcontrolledtrial
AT ndeezigrace maternalandumbilicalcordbloodlactateforpredictingperinataldeathasecondaryanalysisofdatafromarandomizedcontrolledtrial