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Normal Range for Lactic Acid During Pregnancy and Labor: A Systematic Review and Meta-analysis of Observational Studies
Abstract Number: S3A-4
Abstract Type: Original Research
Background: Lactic acid is an important marker for the severity and management of sepsis. The Surviving Sepsis Campaign Guidelines suggest using lactic acid levels to guide resuscitation for lactate levels >4mmol/L.(1) Lactic acid levels>4mmol/L have been associated with increased mortality, and recently intermediate levels of lactic acid (≥2 and <4mmol/L) have also been associated with increased risk of mortality.(2) The Saving Lives, Improving Mothers’ Care report for 2009-2012 recommends immediate intervention for septic patients with a lactic acid level > 2.0 mmol/L.(3) However, the expected range of lactic acid during normal healthy pregnancy and labor is unclear. This study aimed to systematically review the literature to establish the normal range of lactic acid in healthy pregnant women.
Methods: Ovid MEDLINE, Embase.com, and Clinicaltrials.gov were searched to identify published clinical studies that reported maternal lactic acid in healthy pregnant women. All abstracts and full text papers were reviewed and data were collected by two authors. All articles citing the selected articles as well as the bibliographies of selected articles were also screened for inclusion. We computed an aggregate mean and two standard deviations for each time period using the inverse variance weighting technique with a fixed effects model. Analyses were performed separately for each time period(1st, 2nd, 3rd trimesters, scheduled cesarean delivery, early labor, active labor, 2nd stage of labor, and delivery).
Results: Overall, 1799 studies were evaluated and 22 studies met inclusion criteria. There were 1193 patients, and 2008 observations identified. All time periods had aggregate means and two standard deviation ranges less than 4mmol/L. All labor periods(early labor, active labor, 2nd stage of labor, and delivery) had a range higher than 2mmol/L. While the overall ranges did not cross 4mmol/L, many of the individual studies during labor reported ranges >4mmol/L. Outside of labor, all ranges were less than 2mmol/L.
Discussion: Outside of labor, pregnant women can be expected to have lactic acid levels less than 2mmol/L. During labor and delivery, however, there is wide variability in the range of lactic acid. Lactic acid is unreliable during labor as a marker of infection since many healthy pregnant women may have a lactic acid level that is elevated in absence of infection.
Acknowledgment: Ruth Cassidy MS also contributed to this meta-analysis.
1. Rhodes A,et al.Surviving Sepsis Campaign:International Guidelines for Management of Sepsis and Septic Shock:2016.Crit Care Med 2017
2. Puskarich MA,et al.Prognosis of emergency department patients with suspected infection and intermediate lactate levels:a systematic review.J Crit Care 2014
3. Knight M,et al.Saving Lives,Improving Mothers' Care-Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-2012:University of Oxford 2014