الفهرس 
Physiological aspects of Oxygen delivery to the fetusOnly 14 pages are availabe for public view
 |  | from | 141 |  |  |
| | | from | 141 | | |
Abstract
The ability to diagnose fetal life through auscultation of the fetal heart by applying the ear to the pregnant woman’s abdomen was discovered in Europe during the early 19th century. Stethoscopic auscultation of the fetal heart developed throughout the century, as its potential to recognize fetal wellbeing was realized. Interest grew in how to recognize changes in FHR that might foreshadow and prevent intrapartum fetal death through obstetric intervention.
EFM was introduced with an aim of reducing perinatal mortality and cerebral palsy. This reduction has not been demonstrated and, in turn, an increase in maternal intervention rates has been shown in systematic reviews and RCTs. However, the lack of improvement in neonatal outcome and also the increase in intervention rates should be viewed with caution, given the low incidence of the outcomes EFM seeks to reduce.
Aiming to decrease undue interventions the fetal blood sample (FBS) is used to assess fetal acid-base status where fetal surveillance is pathological .
Compared to scalp ph measurements ,lactate measurements were possible at an earlier cervical dilatation and used a smaller sample volume and had a significantly lower sampling failure rate.
Cut off value of scalp lactate that indicates fetal hypoxia and mandates immediate delivery is still controversial ranging from 3 to 5 mmol/L .
This study aims at testing the validity of setting a cut off level for scalp lactate at 4.2 mmol/L as an indicator for intervention during labor in order to achieve satisfactory neonatal and maternal outcomes.
This study included one hundred women in whom pathological fetal heart rate patterns have been detected on external electronic fetal heart rate monitoring. The last fetal scalp lactate before delivery was recorded .
The following parameters will be used to assess neonatal outcome:
1 Apgar scores after 1 and 5 minutes.
2 Neonatal umbilical cord blood acid-base status.
3 NICU admission due to birth related events ( e.g. Neonatal convulsions and Neonatal encephalopathy )
Maternal outcome refers to the occurrence of interventions (operative vaginal delivery or cesarean section ) for fetal indications.
The data was analyzed and TG-ROC curve was used to detect the best lactate level that can predict fetal compromise .
Lactate level of 4.6 mmol/L was found to be the most accurate to predict fetal acidosis.
Further studies are recommended to ensure the safety of delaying intervention till this level.