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DOI: 10.1055/a-2302-8828
A Prospective Study of Lactate Levels in Uncomplicated Spontaneous and Induced Labor
Funding This project was supported in part by funding from the Parkland Community Health Plan, a component unit of Dallas County Hospital District d/b/a Parkland Health.
Abstract
Objective Maternal pushing can yield lactate levels that are above the normal range for nonpregnant individuals. Many hospitals require lactate levels as part of sepsis bundles, and this can confuse the clinicians when measured during labor. The objective of this study was to observe lactate levels in uncomplicated labor.
Study Design This was a prospective study of patients presenting to Labor and Delivery in early labor. Patients met inclusion criteria if they presented at 37 weeks' gestation or greater and were either 3 to 4 cm dilated, in early labor with rupture of membranes less than 12 hours, or were being induced for oligohydramnios or postdates gestation. A baseline maternal lactate level was collected at enrollment. Further levels were collected at complete cervical dilation and every 30 minutes during the second stage of labor up to 3 hours or until delivery.
Results From January 7, 2021, through December 30, 2021, a total of 148 screened patients met the inclusion criteria and 38 were enrolled. Eight (21%) patients withdrew after baseline lactate level was drawn. Twenty-three (61%) patients had a level drawn at complete dilation. Of the 12 (32%) patients with a lactate level drawn at complete and after 30 minutes of pushing, the mean change in lactate level was 2.0 ± 1.8 mmol/L or 0.07 ± 0.06 mmol/L/min (p < 0.01). This change is more pronounced in the second stage of labor for patients with chorioamnionitis (2.6 mmol/L), although this difference is not statistically significant (p = 0.41).
Conclusion Lactate levels increase significantly once a patient reaches complete cervical dilation within 30 minutes of pushing. This increase is more pronounced, although significantly, in patients with chorioamnionitis. As sepsis is one of the leading causes of maternal morbidity and mortality, this pilot study is relevant for providers to see the natural course of lactate levels in labor.
Key Points
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The change in lactate level during normal labor is unknown.
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We measured lactate levels in uncomplicated labor.
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Lactate levels can be elevated in uncomplicated labor.
Publication History
Received: 21 February 2024
Accepted: 24 March 2024
Accepted Manuscript online:
09 April 2024
Article published online:
30 April 2024
© 2024. Thieme. All rights reserved.
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References
- 1 Chinn JJ, Eisenberg E, Artis Dickerson S. et al. Maternal mortality in the United States: research gaps, opportunities, and priorities. Am J Obstet Gynecol 2020; 223 (04) 486-492.e6
- 2 Joseph KS, Boutin A, Lisonkova S. et al. Maternal mortality in the United States: recent trends, current status, and future considerations. Obstet Gynecol 2021; 137 (05) 763-771
- 3 Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-related mortality in the United States, 2011-2013. Obstet Gynecol 2017; 130 (02) 366-373
- 4 Trost SL, Beauregard J, Njie F. et al. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017–2019. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2022
- 5 Singer M, Deutschman CS, Seymour CW. et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (08) 801-810
- 6 Rhodes A, Evans LE, Alhazzani W. et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017; 43 (03) 304-377
- 7 Plante LA, Pacheco LD, Louis JM. Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org. SMFM Consult Series #47: Sepsis during pregnancy and the puerperium. Am J Obstet Gynecol 2019; 220 (04) B2-B10 Erratum in: Am J Obstet Gynecol. 2021 Feb;224(2):224. PMID: 30684460
- 8 Bowyer L, Robinson HL, Barrett H. et al. SOMANZ guidelines for the investigation and management sepsis in pregnancy. Aust N Z J Obstet Gynaecol 2017; 57 (05) 540-551
- 9 Evans L, Rhodes A, Alhazzani W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47 (11) 1181-1247
- 10 Nalbandian M, Takeda M. Lactate as a signaling molecule that regulates exercise-induced adaptations. Biology (Basel) 2016; 5 (04) 38
- 11 Orringer CE, Eustace JC, Wunsch CD, Gardner LB. Natural history of lactic acidosis after grand-mal seizures. A model for the study of an anion-gap acidosis not associated with hyperkalemia. N Engl J Med 1977; 297 (15) 796-799
- 12 Cunningham F, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM. eds. Physiology of Labor. In: Williams Obstetrics, 26e. McGraw Hill; 2022. Accessed February 3, 2023 at: https://obgyn-mhmedical-com.foyer.swmed.edu/content.aspx?bookid=2977§ionid=263817742
- 13 Dockree S, O'Sullivan J, Shine B, James T, Vatish M. How should we interpret lactate in labour? A reference study. BJOG 2022; 129 (13) 2150-2156
- 14 Bauer ME, Balistreri M, MacEachern M. et al. Normal range for maternal lactic acid during pregnancy and labor: a systematic review and meta-analysis of observational studies. Am J Perinatol 2019; 36 (09) 898-906