The introduction of umbilical cord lactate measurement and associated neonatal outcomes in a South African tertiary hospital labor ward

Abstract

Purpose: To investigate the utility of umbilical artery (UA) lactate measurements in a South African hospital for assessing intrapartum care and predicting neonatal outcomes.

Materials and methods: From 3 March–12 November 2014, we conducted a prospective cohort study of UA lactate levels at Kalafong Hospital, Pretoria, South Africa. Following birth, a UA blood sample (<0.5uL) was taken from a double-clamped segment of cord and the lactate measured. Maternal and neonatal characteristics and outcomes were recorded.

Results: During the study, there were 4668 deliveries; including 1091 emergency cesarean and 154 instrumental deliveries. A lactate was recorded for 946 deliveries (20.3%). 190 babies required neonatal resuscitation, with an optimal cutoff for lactate of 5.45 mmol/L (sensitivity 68%, specificity 72%). 124 babies required nursery admission with the optimal cutoff for lactate 4.95 mmol/L (sensitivity 61%, specificity 59%). 55 babies had an Apgar score <7 at 5 min and the optimal lactate for this outcome was 5.65 mmol/L (sensitivity 64%, specificity of 69%).

Conclusions: Umbilical lactate can be used in a middle-low resource setting as a measurement of intrapartum hypoxia, with reasonable sensitivity and specificity for the prediction of, or need for, resuscitation, admission to the nursery, and low Apgar scores.

Keywords:

• Lactate
• intrapartum
• resuscitation
• neonatal
• South Africa

Acknowledgements

The authors would like to thank the midwives, doctors, and women of Kalafong Hospital for their support in running this study.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

EA is a PhD candidate funded by the University of Western Australia with an Australian Postgraduate Award, and an Athelstan and Amy Saw Medical top-up scholarship, and by the Women and Infants Research Foundation with a Gordon King Doctor of Philosophy scholarship.