 |
 |
|
The Solution for Dysfunctional Labor |
  |
 Bill & Melinda Gates Foundation supports research on the effect of the lactate concen-tration in amniotic fluid (AFL) on labor outcome, focusing on reducing maternal and infant mortality in developing countries. British BBC states:
"A test which could stop women labouring for hours in the hope of a "normal" birth only to end up with a Caesarean section has been developed in Sweden". Canadian TV highlights AFL-monitoring in an inteview with ObsteCare's CEO Johan Ubby Listen to the interview here >> |
AFL Clinical application
An obstetrician is often faced with a situation where the progress of labor has been arrested and the Action Line in the partogram has been passed. Many of these deliveries will result in normal vaginal deliveries. However, there is a significant number of these women who will go through a long, painful, parturition that will ultimately end in a caesarean, ventouse or forceps delivery.
In this situation, the appropriate action is often decided under the pressure of time. A normal vaginal delivery is the preferred option, while a long drawn out labor will put heavy strain on both the fetus and the mother. This can lead to complications such as fetal asphyxia or future pelvic floor dysfunction.
If the membranes are already ruptured, the current standard management for dysfunctional labor is oxytocin infusion. However it is well known that oxytocin might be ineffective in many situations, and does not significantly reduce the caesarean rate (see references).
Scientific background
It has earlier been shown in several experimental studies (see references) that the uterus, like other muscles, is a lactate producer. There is substantial evidence that a raised lactate level in the uterine muscle leads to inhibition of muscle contractions, which is described as “dysfunctional labor” or “labor dystocia”.
A recent study shows that it is possible to monitor the state of the uterus by measuring lactic acid in amniotic fluid. The study also shows the possibility for prediction of the mode of delivery early in the delivery process, by measuring lactic acid in amniotic fluid, the AFL-level. (see references).
AFL monitoring in practice
For the first time we have a tool, to support a correct clinical decision, in the above described clinical situation. A high level of lactic acid in amniotic fluid indicates that the uterus is exhausted. To stimulate this kind of labor with a oxytocin infusion would be like asking a marathon runner to run an extra 10,000 meters after she or he has passed the finish line.
By measuring AFL (Amniotic Fluid Lactate level) in a slow progressing labor, you will have a better understanding of the situation and better guide of how to proceed.
A normal level of AFL is a strong indication that using oxytocin according to normal treatment protocols will result in a spontaneous vaginal delivery.
On the other hand, a high level of AFL is a strong indication that using oxytocin will not improve the probability for a spontaneous vaginal delivery and that the delivery will end in operative intervention. However, if high AFL levels are avoided or appropriately taken care of during active labor, the probability for a spontaneous vaginal delivery is increased and an unnecessarily operative delivery may be avoided. |
