Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress: randomised controlled multicentre trial

doi:10.1136/bmj.39553.406991.25

BMJ 2008;336:1284-1287 (7 June), doi:10.1136/bmj.39553.406991.25 (published 25 May 2008)

Research

Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress: randomised controlled multicentre trial

E Wiberg-Itzel, consultant obstetrician¹, C Lipponer, consultant obstetrician², M Norman, consultant obstetrician³, A Herbst, consultant obstetrician⁴, D Prebensen, consultant obstetrician⁵, A Hansson, consultant obstetrician⁶, A-L Bryngelsson, consultant obstetrician⁷, M Christoffersson, consultant obstetrician⁸, M Sennström, senior registrar⁹, U-B Wennerholm, consultant obstetrician², L Nordström, consultant obstetrician, head of department⁹

¹ Departments of Obstetrics and Gynaecology Söder Hospital, Stockholm, ² Sahlgrenska University Hospital, East, Gothenburg, ³ Danderyd Hospital, Stockholm, ⁴ Lund University Hospital, Lund, ⁵ Trollhättan Central Hospital, Trollhättan, ⁶ Karlstad Central Hospital, Karlstad, ⁷ Örebro University Hospital, Örebro, ⁸ Kalmar County Hospital, Kalmar, ⁹ Karolinska University Hospital, Karolinska Institute, 171 76 Stockholm, Sweden

Correspondence to: L Nordström lennart.nordstrom{at}karolinska.se

Objective To examine the effectiveness of pH analysis of fetalscalp blood compared with lactate analysis in identifying hypoxiain labour to prevent acidaemia at birth.

Design Randomised controlled multicentre trial.

Setting Labour wards.

Participants Women with a singleton pregnancy, cephalic presentation,gestational age $≥$ 34 weeks, and clinical indication for fetalscalp blood sampling.

Interventions Standard pH analysis (n=1496) or lactate analysis(n=1496) with an electrochemical microvolume (5 µl) teststrip device. The cut-off levels for intervention were pH <7.21and lactate >4.8 mmol/l, respectively.

Main outcome measure Metabolic acidaemia (pH <7.05 and basedeficit >12 mmol/l) or pH <7.00 in cord artery blood.

Results Metabolic acidaemia occurred in 3.2% in the lactategroup and in 3.6% in the pH group (relative risk 0.91, 95% confidenceinterval 0.61 to 1.36). pH <7.00 occurred in 1.5% in thelactate group and in 1.8% in the pH group (0.84, 0.47 to 1.50).There was no significant difference in Apgar scores <7 at5 minutes (1.15, 0.76 to 1.75) or operative deliveries for fetaldistress (1.02, 0.93 to 1.11).

Conclusion There were no significant differences in rate ofacidaemia at birth after use of lactate analysis or pH analysisof fetal scalp blood samples to determine hypoxia during labour.

Trial registration ISRCT No 1606064.

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