Effect of delayed sampling on umbilical cord arterial and venous lactate and blood gases in clamped and unclamped vessels
Open accessAbstract
Background: Cord blood lactate at birth is a marker of antenatal hypoxia, and is comparable to pH as a prognostic tool. Objective: To determine, by a prospective observational study, the effect of delayed sampling from arteries and veins that were double clamped to isolate the blood from the placenta (clamped), and from vessels that were not isolated from the placenta (unclamped). Methods: Paired samples taken from clamped and unclamped vessels at 0, 20, 40, and 60 minutes were analysed for lactate, base excess, pH, and P co 2. Data were analysed as the change from time 0 at 20, 40, and 60 minutes. Results: Thirty eight placentas of infants delivered by elective caesarean section were studied. Arterial samples were taken from 20 placentas, and venous samples from 18 placentas. Arterial and venous lactate was significantly higher than at time 0 by 20 minutes in both clamped and unclamped vessels. Changes in unclamped vessels were greater than in clamped vessels. The pH remained unchanged over 60 minutes in clamped vessels, but changed significantly in unclamped vessels. Base excess changed significantly in both clamped and unclamped vessels. Conclusions: Cord blood samples taken after 20 minutes delay are unreliable for lactate measurement, even if the vessel has been doubly clamped to isolate the blood from the placenta. Current guidelines that state that blood can be sampled from a clamped cord for up to one hour after delivery should not apply to the interpretation of lactate or base excess. Delayed sampling from unclamped cords is very unreliable.
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In double-clamped cords, the arterial lactate concentration increases linearly with time, and a 10-minute delay of analysis will result in an approximately 0.6 mmol/L higher value, irrespective of mode of delivery and initial value.
“In double-clamped cords, the arterial lactate concentration increases linearly with time, and a 10-minute delay of analysis will result in an approximately 0.6 mmol/L higher value, irrespective of mode of delivery and initial value.69,71”
From Umbilical cord pH, blood gases, and lactate at birth: normal values, interpretation, and clinical utility. (2023) · cites this paper as [69]
Table 2 reports a mean arterial lactate increase of 1.2 mmol/L after 20 minutes in double-clamped cords, consistent with an approximate rate of 0.6 mmol/L per 10 minutes; the discussion describes the change as linear. But the study measured delayed sampling at 20-minute intervals, not a 10-minute delay in analysis. Its participants delivered by elective caesarean section and were metabolically normal at birth, so it does not establish the result irrespective of delivery mode or initial value. (LLM, conf=0.90)
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- Authors
- Armstrong, L., & Stenson, B.
- Affiliations
- Edinburgh Royal Infirmary (GB)
- Corresponding author
- Armstrong, L
- ORCID
- Armstrong, L
- Venue
- Archives of Disease in Childhood - Fetal and Neonatal Edition
- Publisher
- BMJ
- Published
- 2006-04-25
- Volume
- 91
- Issue
- 5
- Pages
- F342-F345
- ISSN
- 1359-2998 (ISSN-L)
- 1468-2052
- PMC
- PMC2672835
- OpenAlex
- W2168655168
- Cited by
- 45
- References
- 16
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 4 · 2021: 2 · 2020: 7 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 3 · 2015: 3 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 2.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Disease in Childhood Fetal & Neonatal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- umbilical cord clamping, antenatal hypoxia, base excess, blood pH, umbilical artery, umbilical vein, placental blood, cordocentesis, cesarean section
- MeSH terms
- Acid-Base Equilibrium, Blood Specimen Collection, Carbon Dioxide, Constriction, Fetal Hypoxia, Fetal Blood, Humans, Hydrogen-Ion Concentration, Infant, Newborn, Partial Pressure, Prospective Studies, Time Factors, Umbilical Arteries, Umbilical Veins, Lactic Acid
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