LACTATE AND PYRUVATE AS AN INDEX OF PRENATAL OXYGEN DEPRIVATION

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Abstract
The concentrations of lactate and hydrogen ions in maternal and fetal blood indicate that their net movement is from fetus to mother. Since these ions can cross the placenta in either direction, maternal acidosis will be reflected in the fetus. Low absolute values for lactate in both umbilical vein and artery of vigorous infants at birth indicate that under optimal conditions the fetus derives only a small proportion of energy from anaerobic glycolysis. Infants born following prolonged or complicated labors during which oxygen supply to the fetus is likely to be impaired are more acidotic and have significantly higher lactate levels. The concentration of pyruvate at birth shows no consistent relationship to the clinical condition of the infant, and neither the ratio of lactate to pyruvate nor excess lactate appears to be a better index of prenatal oxygen deprivation than the concentration of lactate. The acid-based components of amniotic fluid do not correlate either with the lactate concentration in fetal blood nor with the clinical condition of the infant at birth. In the minutes following birth, there is a further fall in blood pH, presumably due to a delayed influx of hydrogen ion from tissues. Thus, the composition of cord blood does not fully reflect the degree of fetal asphyxia during labor and delivery.
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