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Fetal Scalp Lactate Testing During Intrapartum Pregnancy with Abnormal Fetal Heart Rate: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Published on: March 26, 2018
Project Number: RC0974-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of fetal scalp lactate testing for managing intrapartum pregnancy with abnormal fetal heart rate?
  2. What is the cost-effectiveness of fetal scalp lactate testing for managing intrapartum pregnancy with abnormal fetal heart rate?
  3. What are evidence-based guidelines informing the use of fetal scalp lactate testing for managing intrapartum pregnancy with abnormal fetal heart rate?

Key Message

One systematic review with meta-analysis and three evidence-based guidelines were identified for this review. No evidence regarding the cost-effectiveness of fetal scalp lactate testing for managing intrapartum pregnancy with abnormal fetal heart rate was identified. The authors of the systematic review concluded that the available evidence (which had low to unclear risk of bias) indicated that fetal scalp lactate testing was more likely to be successful with fewer scalp incisions and the results were available in less time than with pH estimation. The results of the meta-analysis suggested that lactate and pH tests did not significantly differ from each other for a large number of neonatal outcomes including neonatal encephalopathy, death from congenital abnormalities, Apgar score at five minutes, admission to NICU, umbilical cord pH or base deficit values, metabolic acidemia, number of additional tests performed per fetus to evaluate fetal well-being, mode of birth, and operative birth for non-reassuring fetal status.The three guidelines each recommended the use of fetal scalp blood sampling for women in labour when there is an abnormal or non-reassuring cardiotocography result. Two of these guidelines made a recommendation for testing, but did not specifically compare the effectiveness of the two tests; however, they did note that lactate measurement provides an easier and more affordable adjunct to continuous electronic fetal monitoring for some facilities. The third guideline recommended the use of either lactate or pH testing to interpret fetal blood sample results. All three guidelines made recommendations regarding lactate concentration ranges for the classification of fetal blood sample results. None of the included studies were conducted in Canada and thus the results may not be generalizable to the Canadian setting.

Tags

diagnostic tests, acidosis, lactic, fetal distress, fetal hypoxia, fetal monitoring, fetus, lactic acid