Proposed cut‐off for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a large prospective observational study

ObjectivesCapillary blood lactate testing with handheld analysers has great advantages to reduce the time needed for clinical decisions, and for extended use in the prehospital setting. We investigated the agreement of capillary lactate measured using handheld analysers (CL-Nova and CL-Scout+ measured by Nova and Lactate Scout+ analyzers) and the reference venous level assessed using a point-of-care testing (POCT) blood gas analyser (VL-Ref).DesignA prospective observational study.SettingA university teaching hospital emergency department in Hong Kong.ParticipantsPatients triaged as ‘urgent’ (Category 3 of a 5-point scale), aged ≥18 years during 2016 were eligible. 240 patients (mean age 69.9 years) were recruited.Primary and secondary outcome measuresThe primary outcome measure was the agreement of the capillary blood lactate level measured by handheld lactate analyser when compared with the reference standard technique, namely venous blood samples obtained by venepuncture and analysed using the blood gas analyser. The secondary outcome measure was the difference in values of venous lactate using blood gas analysers and handheld lactate analysers.ResultsThe results of VL-Ref ranged from 0.70 to 5.38 mmol/L (mean of 1.96 mmol/L). Regarding capillary lactate measurements, the bias (mean difference) between VL-Ref and CL-Scout+ was −0.22 with 95% limits of agreement (LOA) of −2.17 to 1.73 mmol/L and the bias between VL-Ref and CL-Nova was 0.46, with LOA of −1.08 to 2.00 mmol/L. For venous lactate, results showed the bias between VL-Ref and VL-Scout+ was 0.22 with LOA being −0.46 to 0.90 mmol/L, and the bias between VL-Ref and VL-Nova was 0.83 mmol/L with LOA −0.01 to 1.66 mmol/L.ConclusionOur study shows poor agreement between capillary lactate and reference values. The study does not support the clinical utility of capillary lactate POCT. However, venous lactate measured by Scout+ handheld analyser may have potential for screening patients who may need further testing.Trial registration numberNCT02694887.

Download Full-text

Evaluating the value of intrapartum fetal scalp blood sampling to predict adverse neonatal outcomes: A UK multicentre observational study

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2019.06.012 ◽

2019 ◽

Vol 240 ◽

pp. 62-67 ◽

Cited By ~ 3

Author(s):

Bassel H. Al Wattar ◽

Aarti Lakhiani ◽

Adalina Sacco ◽

Aditi Siddharth ◽

Alexandra Bain ◽

...

Keyword(s):

Observational Study ◽

Blood Sampling ◽

Neonatal Outcomes ◽

Adverse Neonatal Outcomes ◽

Fetal Scalp ◽

Fetal Scalp Blood Sampling

Download Full-text

Perinatal outcomes in women with in vitro fertilization pregnancies hospitalized for late moderate-to-critical ovarian hyperstimulation syndrome: A prospective observational study

10.21203/rs.2.20287/v1 ◽

2020 ◽

Author(s):

Linli Hu ◽

Rui Xie ◽

Mengying Wang ◽

Yingpu Sun

Keyword(s):

Observational Study ◽

Live Birth ◽

Ovarian Hyperstimulation Syndrome ◽

Prospective Observational Study ◽

Incidence Rates ◽

Obstetric Complications ◽

Neonatal Outcomes ◽

Premature Delivery ◽

Complication Rates ◽

Ovarian Hyperstimulation

Abstract Background Ovarian hyperstimulation syndrome (OHSS) is a common disease during controlled ovarian hyperstimulation treatment. However, the obstetrics and neonatal outcomes of these group of patients are barely known. The aim of this study was to explore the effects of late moderate-to-critical ovarian hyperstimulation syndrome (OHSS) on obstetric and neonatal outcomes. Methods This is a prospective observational study including 17,537 patients after IVF/ICSI-fresh embryo transfer (ET) from June 2012 to July 2016, after meeting the inclusion and exclusion criteria, of whom 7064 eligible patients were diagnosed with clinical pregnancy. Finally, 6356 patients were allocated to the control group, and 385 patients who were hospitalized and treated at the center for late moderate-to-critical OHSS were allocated to the OHSS group. Results The live birth delivery and neonatal complication rates did not significantly differ between the OHSS and control groups, and the incidence rates of the obstetric complications venous thrombosis (VT) and gestational diabetes mellitus (GDM) were significantly higher in the OHSS group. Conclusions Late moderate-to-critical OHSS could reduce gestational time, increase obstetric complications and neonatal complications. However, the incidence rates of live birth rate, premature delivery, miscarriage, early abortion, PIH, PP, ICP, average neonatal weight and LBW did not statistically significant difference between the two groups.

Download Full-text

Pregnancy outcomes in women presenting with single versus multiple episodes of reduced fetal movements: A prospective observational study

Indian Journal of Obstetrics and Gynecology Research ◽

10.18231/j.ijogr.2021.074 ◽

2021 ◽

Vol 8 (3) ◽

pp. 356-362

Author(s):

P Pallavee ◽

Prudvi Rani Podili ◽

Rupal Samal ◽

Seetesh Ghose

Keyword(s):

High Risk ◽

Observational Study ◽

Pregnancy Outcomes ◽

Prospective Observational Study ◽

Fetal Movement ◽

Neonatal Outcomes ◽

Reduced Fetal Movements ◽

Fetal Movements ◽

Reduced Fetal Movement ◽

Multiple Episodes

Fetal movement counting may assist clinicians to intervene at the right time and improve perinatal outcomes, but may sometimes cause unnecessary interventions. A recent Cochrane review in 2015 concludes that there is insufficient evidence to influence practice. This prospective observational study was conducted to evaluate pregnancy outcomes of 103 pregnant women presenting with primary complaints of reduced fetal movements to our Institute. All patients underwent ultrasonography (USG) and non-stress testing (NST) as preliminary investigations and were followed up till delivery. Labor outcomes like onset of labor, mode of delivery, neonatal outcomes like APGAR scores, admission to NICU for > 24 hours, birth weight, neonatal complications and maternal complications were noted. One hundred and three pregnant women presented with reduced fetal movements, of whom, 65% were term primigravida between the ages of 18-26 years. 47.5% belonged to the high risk pregnancy group. The rates of admission (62.1%), induction (77.7%) and cesarean section (43.7%) were high in this group. Pregnancy outcomes did not differ between single and multiple episodes of reduced fetal movements. Based on risk categorization we found that a single episode of reduced fetal movement was associated with approximately 70% good neonatal outcomes, whereas there was 50% risk of adverse neonatal outcomes with multiple episodes. Though this was clinically significant we could not establish statistical significance for this result. Reduced fetal movement can occur in both low and high risk pregnant population. Pregnancy outcomes between single and multiple episodes of RFM were not significantly different.

Download Full-text