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Am J Perinatol 2019; 36(11): 1171-1178
DOI: 10.1055/s-0038-1676492
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Association between Uterine Tachysystole during the Last Hour of Labor and Cord Blood Lactate in Parturients at Term Gestation

Arvind Palanisamy
1   Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
,
Julia Lopez
2   Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Antonina Frolova
2   Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
George Macones
2   Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Alison G. Cahill
2   Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
› Author Affiliations
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Publication History

09 September 2018

30 October 2018

Publication Date:
19 December 2018 (online)

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Abstract

Objective To assess whether uterine tachysystole (UT) in labor causes an increase in cord blood lactate.

Study Design Secondary analysis of a prospective cohort study of all consecutive singleton gestations ≥ 37 weeks admitted for labor to a single tertiary care institution with universal cord gas policy. Patients with UT in the last hour (“always”) were compared with those without UT (“never”). Primary outcome of interest was cord blood lactate ≥ 4 mmol/L. Secondary outcomes included pH ≤ 7.10, base deficit ≥ 8 mmol/L, and admission to the neonatal intensive care unit (NICU). Multivariable logistic regression was used to estimate the risk for elevated cord blood lactate after adjusting for maternal age and body mass index.

Results Of the 8,580 patients included in the analysis, 513 experienced UT 1 hour before delivery (5.9%). UT was significantly associated with elevated cord blood lactate in the “always” (33.5%) compared with the “never” group (26%) (adjusted odds ratio 1.47 [1.17, 1.86]; p < 0.01). However, there were no differences in either umbilical arterial pH, base deficit, or NICU admission rates.

Conclusion UT in the last hour preceding delivery increases arterial cord blood lactate suggesting that UT proximate to delivery should be considered as a variable when interpreting cord blood gas values.

Keywords

uterine tachysystole - oxytocin - labor - cord blood lactate
 

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