A pilot study to determine the feasibility of collecting amniotic fluid samples from women during labour and measuring amniotic fluid lactate at point of care

BMC Research Notes

Sally K Tracy³  Mark B Tracy¹  William D Rawlinson²  Mary Moriatis⁴  Jenna Iwasenko²  Beverley Hall³ 

[1] Centre for Newborn Care, Westmead Hospital, Westmead, NSW 2145, Australia;School of Medical Sciences, Faculty of Medicine, University of New South Wales, Kensington, NSW 2031, Australia;Midwifery and Women’s Health Nursing Research Unit, Royal Hospital for Women, Randwick, NSW 2031, Australia;Department of Clinical Chemistry, South Eastern Area Laboratory Services, Randwick 2031, Australia

关键词: Point of care;    Labour;    Amniotic fluid;    Lactate;    Dystocia;   

Others  :  1143151
DOI  :  10.1186/1756-0500-6-112

 received in 2012-08-17, accepted in 2013-03-18,  发布年份 2013

【 摘 要 】

Background

The level of lactate in amniotic fluid may provide useful clinical information when assessing progress of a woman’s labour and if so, a rapid, reliable method to assess amniotic fluid lactate is required in order to be clinically relevant. However, measuring lactate levels in amniotic fluid, using portable, handheld lactate meters may be less accurate than reference laboratory instruments designed to measure lactate levels in aqueous solutions. Prior to conducting a large study, we assessed recruitment, consent and sampling procedures, and the accuracy of a handheld lactate meter to measure lactate in amniotic fluid. We compared amniotic fluid lactate results obtained using the hand held Lactate Pro (Arkray) to results obtained using reference laboratory methods ABX Pentra 400 (Horiba).

Results

We recruited 35 nulliparous women during their antenatal hospital visits and tested amniotic fluid samples collected from 20 labouring women. The handheld Lactate Pro meter was found accurate from 9–20 mmol/L with a Passing & Bablok regression of y = 0.18 + 0.97x (95% CI 0.76–1.45). Amniotic fluid lactate results remained reliable in the presence of potential contaminants commonly encountered during labour; obstetric lubricant, blood and meconium.

Conclusion

The measurement of amniotic fluid lactate using the Lactate Pro meter was reliable compared to reference laboratory methods for measuring lactate levels in amniotic fluid. The pilot study enabled the refinement of information, recruitment, consenting and sampling procedures prior to commencing a large cohort study.

【 授权许可】

   
2013 Hall et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Lowe N: A review of factors associated with dystocia and caserean section in nulliparous women. Journal of Midwifery Womens Health 2007, 52(3):216-228.
• [2]Li Z, McNally L, Hilder L, Sullivan E: Australia’s Mothers and babies. Sydney: Australian Institute of Health and Werlfare; 2009. [Perinatal statistics series]
• [3]Kjaergaard H, Olsen J, Ottesen B, Nyberg P, Dykes A-K: Obstetric risk indicators for labour dystocia in nulliparous women: a multi-centre cohort study. BMC Pregnancy Childbirth 2008, 8(1):45. BioMed Central Full Text
• [4]National Institute for Health and Clinical Excellence: Intrapartum care: care of healthy women and their babies during childbirth. National Institute for Health and Clinical Excellence; 2007. [NICE clinical guidelines. vol. 55] Accessed March 25, 2012 http://publications.nice.org.uk/intrapartum-care-cg55/guidance webcite
• [5]Neal JL, Lowe NK, Patrick TE, Cabbage LA, Corwin EJ: What is the slowest-Yet-normal cervical dilation rate among nulliparous women with spontaneous labor onset. J Obstet Gynecol Neonatal Nurs 2010, 39:361-369.
• [6]Akerud H, Ronquist G, Wiberg-Itzel E: Lactate distributionin culture medium of human myometrial biopsies incubated under different conditions. Am J Physiol Endocrinol Metab 2009, 297(E):1414-1419.
• [7]Wray S: Insights into the uterus. Exp Physiol 2007, 92(4):621-631.
• [8]Wiberg-Itzel E, Pettersson H, Andolf E, Hansson A, Winbladh B, Akerud H: Lactate concentration in amniotic fluid: a good predictor of labor outcome. Eur J Obstet Gynecol Reprod Biol 2010, 152:34-38.
• [9]Wiberg-Itzel E, Pettersson H, Cnattingius S, Nordstrom L: Association between lactate concentration in amniotic fluid and dysfunctional labor. Acta Obstetricia et Gynecologica Scand 2008, 87(9):924-928.
• [10]Quenby S, Pierce S, Brigham S, Wray S: Dysfunctional labour and myometrial lactic acidosis. Obstet Gynaecol 2004, 104(4):718-723.
• [11]Taggart M, Wray S: Hypoxia and smooth muscle function: key regulatory events during metabolic stress. J Physiol 1998, 509:313-325.
• [12]Ullah M, Davies A, Halestrap A: The plasma membrane lactate transporter MCT 4, but Not MCT1, is up regulated by hypoxi through a HIF-1_ dependent mechanism. Joural of Biology and Chemistry 2006, 281(14):9030-9037.
• [13]Pyne D, Boston T, Martin D, Logan A: Evaluation of the Lactate Pro blood lactate analyser. European Journal Of Applied Physiology 2000, 82(1–2):112-116.
• [14]Tanner R, Fuller K, Ross M: Evaluation of three portable blood lactate analysers: lactate Pro, lactate scout and lactate plus. European Journal Of Applied Physiology 2010, 109(3):551-559.
• [15]Wiberg-Itzel E, Cnattingius S, Nordstrom L: Lactate determination in vaginal fluids: a new method in the diagnosis of prelabour rupture of membranes. BJOG 2005, 112(6):754-758.
• [16]Wiberg-Itzel E, Lipponer C, Norman M, Herbst A, Prebensen D, Hansson A, Bryngelsson AL, Christoffersson M, Sennstrom M, Wennerholm UB: Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress: randomised controlled multicentre trial. BMJ 2008, 336(7656):1284-1287.
• [17]ObsteCare: The solution for dysfunctional labour. Accessed March 25, 2013 http://www.obstecare.com/index.html webcite
• [18]Nordstrom L: Lactate measurements in scalp and cord arterial blood. Current Opinion in Obstetrics and Gynaecology 2001, 13:141-145.
• [19]Pennell CE, Tracy MB, Donald MC: Accurate lactate-a new method for rapid pont of sample measurement of lactate in fetal and neonatal blood. Neonatal Intensive Care 2000, 13(4):53-58.