Elevated amniotic fluid lactate predicts labor disorders and cesarean delivery in nulliparous women at term

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• 作者：Martina Murphy ; BNS^a ; ^c ; ^{tinamurphy@nmh.ie" class="auth_mail" title="E-mail the corresponding author} ; Michelle Butler ; PhD^e ; Barbara Coughlan ; PhD^c ; Donal Brennan ; PhD^b ; ^d ; Colm O&rsquo ; Herlihy ; PhD^b ; ^d ; Michael Robson ; MD^b
• 关键词：active management of labor ; amniotic fluid lactate ; cesarean delivery ; labor disorder (dystocia)
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：213
• 期：5
• 页码：673.e1-673.e8
• 全文大小：716 K

文摘

We sought to assess amniotic fluid lactate (AFL) at diagnosis of spontaneous labor at term (≥37 weeks) as a predictor of labor disorders (dystocia) and cesarean delivery (CD).

Study Design

ra0015">This was a single-institution, prospective cohort study of 905 singleton, cephalic, term (≥37 weeks) nulliparous women in spontaneous labor. A standard management of labor (active management of labor) including a standard oxytocin regimen up to a maximum dose of 30 mU/min was applied. AFL was measured using a point-of-care device (LMU061; ObsteCare, Stockholm, Sweden). Labor arrest in the first stage of labor was defined as the need for oxytocin when cervical dilatation was <1 cm/h over 2 hours and in the second stage of labor by poor descent and rotation over 1 hour. Standard statistical analysis included analysis of variance, Pearson correlations, and binary logistic regression. Unsupervised decision tree analysis with 10-fold cross-validation was used to identify AFL thresholds.

Results

ra0020">AFL was normally distributed and did not correlate with age, body mass index, or gestation. Unsupervised decision tree analysis demonstrated that AFL could be divided into 3 groups: 0-4.9 mmol/L (n = 118), 5.0-9.9 mmol/L (n = 707), and ≥10.0 mmol/L (n = 80). Increasing AFL was associated with higher total oxytocin dose (m>Pm> = .001), labor disorders (m>Pm> = .005), and CD (m>Pm> ≤ .001). Multivariable regression analysis demonstrated that women with AFL ≥5.0-9.9 mmol/L (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.06–2.39) and AFL ≥10.0 mmol/L (OR, 1.72; 95% CI, 1.01–2.93) were independent predictors of a labor disorder. AFL ≥5.0-9.9 mmol/L did not predict CD but multivariable analysis confirmed that AFL ≥10.0 mmol/L was an independent predictor of CD (OR, 3.35; 95% CI, 1.73–6.46). AFL ≥5.0-9.9 mmol/L had a sensitivity of 89% in predicting a labor disorder and a sensitivity of 93% in predicting CD with a 97% negative predictive value. AFL ≥10.0 mmol/L was highly specific but lacked sensitivity for CD. There was no difference in birthweight of infants according to labor disorder and delivery method.

Conclusion

ra0025">AFL at diagnosis of labor in spontaneously laboring single cephalic nulliparous term women is an independent predictor of a labor disorder and CD. These data suggest that women with AFL between 5.0-9.9 mmol/L with a labor disorder may be amenable to correction using the active management of labor protocol.