| ObjectiveTo study the correlation between lactate level, BE of maternal blood and umbilical artery in singleton full-term pregnant women during different mode of delivery. Investigate the predictive value of maternal blood lactate level and BE for the severity of fetal distress,and follow-up the prognosis of the newborns, in order to provide experimental data for predicting the occurrence and severity of fetal distress and neonatal asphyxia with maternal blood lactate level and BE.MethodsSingleton full-term and healthy pregnant women who delivered in the department of Obstetrics and gynecology of the Second Hospital of Shandong University from July2011to February2012were selected for the study. Excluded those who were combined with vaginal delivery contraindications, adverse obstetrical history, pathological pregnancy, medical and surgical diseases, finally we got68cases of pregnant women. According to the mode of delivery,the severity of meconium-stained amniotic fluid,electronic fetal monitoring and neonatal Apgar scores,we divided the68cases into three groups:group A consisted of25cases for elective cesarean section group(all for social factors, exclude when amniotic fluid meconium stained or Apgar score<9), group B consisted of21cases for the vaginal delivery group without fetal distress, group C consisted of22cases for the vaginal delivery group with fetal distress (meconium-stained amniotic fluid Ⅱ or Ⅲ degrees, or adverse fetal heart rate monitoring, or Apgar score<8). We collect2ml of maternal cubital vein blood from elective cesarean section gravida before carrying out anesthesia and vaginal delivery gravida at the same time of delivery with heparinized syringe to detect the lactate level and BE. All newborns should be clamped about a length of20cm of umbilical cord before the first breath immediately, and extract1ml of umbilical artery blood with heparinized syringe, then immediately sealed and delivered to detect blood gas analysis. Follow-up all neonate’s hospitalization and disease after one month. All of the data was analyzed by SPSS16.0software with methods of t-test, one-way AN OVA, Chi-square test and Pearson correlation analysis. We defined that statistical significance exists when P value less than0.05.Results1. Comparison of lactate level1.1The maternal lactate level of group A is (1.77±0.84) mmol/L, which is significantly lower than group B (5.07±1.94) mmol/L and group C (5.44±1.65) mmol/L (P<0.05).There was no statistical difference in maternal lactate level between group B and group C (P>0.05)1.2The umbilical artery lactate level of group C is (4.55±1.97) mmol/L,which is significantly higher than group A (2.25±0.80) mmol/L and group B (3.12±1.20) mmol/L (P<0.05).There was no statistical difference in umbilical artery lactate level between group A and group B (P>0.05)1.3To combine and analyze group B and group C, there was positive correlation between maternal lactate level and umbilical artery lactate level (r=0.458, P<0.01).1.4There was no correlation between maternal lactate level and umbilical artery lactate level in group A (P>0.01)2. Comparison of BE2.1The maternal blood BE of group A is (-0.80±1.25) mmol/L,which is significantly higher than group B (-7.52±2.44) mmol/L and group C (-8.25±2.41) mmol/L (P<0.05).There was no statistical difference in maternal blood BE between group B and group C (P>0.05)2.2The umbilical artery BE of group C is (-5.73±3.32) mmol/L,which is significantly lower than group A (-2.03±2.54) mmol/L and group B (-3.11±1.84) mmol/L (P<0.05).There was no statistical difference in umbilical artery BE between groupA and group B (P>0.05)2.3To combine and analyze group B and group C, there was positive correlation between maternal blood BE and umbilical artery BE (r=0.372, P<0.01)2.4There was no correlation between maternal blood BE and umbilical artery BE in group A (P>0.01)3. Comparison of PHThe umbilical artery PH of group C is (7.20±0.08), which is significantly lower than group A (7.29±0.07) and group B (7.27±0.05)(P<0.05).There was no statistical difference in umbilical artery PH between group A and group B (P>0.05).4. Comparison of neonatal prognosisThere were seven cases of neonatal pneumonia in group C (31.82%), which is significantly higher than one case of group B (4.76%) and two cases of group A (8.00%)(P<0.05). There was only one case of mild neonatal asphyxia in group C, transferred to the pediatric and diagnosed as hypoxic-ischemic encephalopathy. There was no occurrence of neonatal asphyxia and hypoxic-ischemic encephalopathy in group A and group B.5. Comparison of labor duration time5.1Time for first stage of labor in group B and group C were (318.42±57.89) min,(389.32±43.13) min respectively, there was no statistical difference between them (P>0.05).Time for second stage of labor were (25.47±4.77) min,(33.73±5.53) min respectively, there was no statistical difference between them either (P>0.05)5.2To combine and analyze group B and group C, neither maternal blood lactate level nor umbilical artery lactate level were related to the time of the first and second stage of labor (P>0.01) Conclusion1. In the process of vaginal delivery, maternal lactate level and umbilical artery lactate level are positively correlated, but there was no significant difference in maternal blood lactate level between the group of vaginal delivery without fetal distress and the group of vaginal delivery with fetal distress.2. In the process of vaginal delivery, maternal blood BE and umbilical artery BE are positively correlated, but there was no significant difference in maternal blood BE between the group of vaginal delivery without fetal distress and the group of vaginal delivery with fetal distress. The incidence of neonatal metabolic acidosis in the group of vaginal delivery with fetal distress was significantly higher than the group of vaginal delivery without fetal distress and the group of elective cesarean section.3. Data provided by this study suggested that lactate level of maternal blood and umbilical artery were not related to the duration time of labor.4. In the process of vaginal delivery, most of the pregnant women occur metabolic acidosis.SignificanceCord blood lactate level and BE are reliable indicators for the evaluation of the severity of fetal distress. Data provided by this study suggested that lactate level and BE of maternal blood are positively correlated with the lactate level and BE of umbilical artery during vaginal delivery, but there was no significant difference in maternal blood lactate level and BE between the group of vaginal delivery without fetal distress and the group of vaginal delivery with fetal distress, therefore,maternal blood lactate level and BE can not be used to predict the occurrence and severity of fetal distress and neonatal asphyxia during labor. |
PDF Full Text Request