| ObjectivesThe purpose of this study was to explore the evaluation value of non-reassuring fetal heart rate(FHR) patterns by uric acid and lactate tested in both amniotic fluid and newborn cord blood, to distinguish which pattern was positive and the medical procedure the obstetrician took correctly and promptly, to study the relationship between the level of uric acid, lactate and non-reassuring FHR patterns and provide experimental evidence for obstetricians and pediatricians as the based evidence follow up the outcome of newborns who had non-reassuring FHR patterns.MethodsFrom January 2010 to December 2010 in Jinan Maternity and Child Health Care Hospital, a total of 134-term singleton pregnant women who accepted elective or emergent cesarean section (CS) were chosen and divided into two groups: 59 cases with non-reassuring FHR patterns as the study group and 75 cases with the normal patterns as the control group. Amniotic fluid and umbilical artery blood were collected during and immediately after the CS, the levels of uric acid and lactate were measure.Results1. Uric acid and lactate levels of the amniotic fluidThere were significant differences in mean uric acid level (575.22±136.08μmol/L vs 514.61±102.08μmol/L, P=0.004), lactate level (5.33±1.11mmol/L vs 4.91±0.99mmol/L, P=0.022) of the amniotic fluid in cases with non-reassuring FHR patterns compared with controls. The uric acid and lactate levels were highest in the abnormal patterns, higher in the suspicious patterns, lowest in the controls. There were significant differences in mean uric acid level and mean lactate level in the abnormal FHR patterns compared with controls. There was no significant difference in mean uric acid level and mean lactate level between suspicious FHR patterns and controls. Uric acid level of the amniotic fluid were higher in the study group with meconium-stained amniotic fluid(MSAF) than that in clear AF, but there was no statistical significance(P=0.21), lactate level of the amniotic fluid was also higher in the study group with MSAF than that of clear AF, but there was no statistical significance(P=0.06) too.2. Uric acid and lactate levels of the umbilical artery bloodUric acid level of the umbilical artery blood was significantly higher in the study group than that in control group (211.86±53.73μmol/L vs 187.15±45.94μmol/L, P=0.005). Lactate level of the umbilical artery blood was also higher in the study group than that in the control group(2.87±0.78mmol/L vs 2.61±0.47mmol/L)and there was statistical significance (P=0.021) too. The uric acid and lactate levels were highest in the abnormal FHR patterns, higher in the suspicious patterns, lowest in the controls. There were significant differences in mean uric acid level and lactate level in the abnormal patterns compared with controls. There were no significant differences in mean lactate level and lactate level between suspicious and controls. Uric acid level of the umbilical artery blood was higher in the study group with MSAF than that of clear AF, but there was no statistical significance (P=0.298).Lactate level of the umbilical artery blood was also higher in the study group with MSAF than that of clear AF, but there was no statistical significance (P=0.147) too.3. CorrelationThere was positive correlation between the uric acid level of the amniotic fluid and the umbilical artery blood(r=0.883). There was positive correlation between the lactate level of the amniotic fluid and the umbilical artery blood(r=0.795).4. Diagnostic values of uric acid and lactate levelThe distributions of uric acid, lactate in control group were nearly normal. Thus the ranges of normal value for AF uric acid, lactate were set as 491.13~538.10μmol/L, 4.68~5.13mmol/L, respectively. The ranges of normal value for umbilical artery blood uric acid, lactate were set as 176.58~197.72μmol/L, 2.51~2.72mmol/L,respectively.If we adopted AF uric acid level 538.1μmol/L as the upper borderline to diagnose fetal distress, the sensitivity, specificity, positive predictive value and negative predictive value were 87.5%, 77.78%, 82.35%, 84%, respectively. If we adopted AF lactate level 5.13mmol/L as the upper borderline to diagnose fetal distress, the sensitivity, specificity, positive predictive value and negative predictive value were 75%, 81.48%, 82.79%, 73.33%, respectively. If we adopted umbilical artery blood uric acid level to diagnose fetal distress, taking 197.72μmol/L as the upper borderline, the sensitivity, specificity, positive predictive value and negative predictive value were 90.63%, 70.37%, 78.38%, 86.36%, respectively. If we adopted umbilical artery blood lactate level to diagnose fetal distress, taking 2.72mmol/L as the upper borderline, the sensitivity, specificity, positive predictive value and negative predictive value were 78.13%, 81.48%, 83.33%, 75.88%, respectively. Conclusions1. AF uric acid and lactate detection have positive value for accurately diagnosing fetal distress in cases of non-reassuring FHR patterns. AF uric acid is more sensitive and has more positive predictive value than AF lactate; Umbilical artery uric acid and lactate also have positive value for accurately diagnosing fetal distress in cases of non-reassuring FHR patterns.2. There were positive correlations between the uric acid level and lactate level of the amniotic fluid, the umbilical artery blood respectively, and their predictive value of fetal distress are similar. Both detection of uric acid and lactate in AF,umbilical artery can be used for assessment of non- reassuring FHR patterns, and both are quite helpful in clinical treatment.3.AF uric acid, lactate are higher in study group than that in control group especially in abnormal FHR patterns andⅢMSAF are the highest, so we must pay more attention to those cases, the result also suggest that obstetricians and pediatricians should pay attention to those newborns who had both abnormal FHR patterns and high uric acid,lactate levels but with normal Apgar score in clinical practice. |
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