Official publication of Rawalpindi Medical University
Measurement Of Umbilical Venous Lactate Levels For Predicting Poor Neonatal Outcomes

Supplementary Files


How to Cite

Habib M, Qureshi MA, Sohail I. Measurement Of Umbilical Venous Lactate Levels For Predicting Poor Neonatal Outcomes. JRMC [Internet]. 2024 Mar. 8 [cited 2024 Jun. 15];28(1). Available from:


Objectives: To determine the utility of umbilical venous lactate measurements for predicting poor neonatal outcomes.

Method: This observational study was conducted at Kahuta Research Laboratories (KRL) hospital, Islamabad from May 2019 to October 2019. Singleton pregnancies with no known fetal congenital anomalies and gestational age greater than 28 weeks were included. Descriptive statistics were used to analyse the characteristics of study subjects and also composite neonatal outcomes. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.

Result: Umbilical venous lactate levels were found to be highest in instrumental deliveries (48.7%) and lowest in those delivered by elective cesarean section (25.7%). Low APGAR score, need for initial resuscitation & neonatal intensive care unit admission, mechanical ventilation and neonatal morbidity were all associated with significantly higher lactate levels. Based on the maximal yield index, the optimal cut-off point for predicting neonatal morbidity was 46.5mg/dl (area under the receiver operating characteristics curve was 0.8). Based on this optimal cut-off point, it has a sensitivity of 62%, specificity of 92%, PPV 51% and NPV 94% for neonatal morbidity.

Conclusion: Umbilical venous lactate measurement is a good predictor of poor neonatal outcome especially in situations when umbilical arterial blood cannot be taken due to technical difficulty. Mode of delivery has a strong association with fetal hypoxia and raised umbilical lactate levels.

Keywords: lactate, neonatal outcomes, labour ward.


1. Heller G, Schnell RR, Misselwitz B, Schmidt S. Umbilical blood pH, Apgar scores, and early neonatal mortality. Z Geburtshilfe Neonatol 2003;207:84-9. [PubMed]
2. National Collaborating Centre for Women’s and Children’s Health. Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth. Clinical Guideline. London: RCOG Press, 2007.
3. Nordstrom L et al. Fetal and maternal lactate increase during active second stage of labour. BJOG. 2001;108:263–268. [PubMed]
4. Waqar T, Haque KN. Umbilical cord blood gas and lactate levels as a marker of birth asphyxia in neonates with particular reference to resource limited countries. Pak Paed J Oct - Dec 2013;37:197-203. [PakMediNet]
5. Tuuli MG et al. Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term. Obstet Gynecol. 2014;124:756–61. [PMC free article] [PubMed]
6. Wiberg N, Kallen K, Olofsson P. Base deficit estimation in umbilical cord blood is influenced by gestational age, choice of fetal fluid compartment, and algorithm for calculation. Am J Obstet Gynecol. 2006;195:1651–6. [PubMed]
7. Tuuli MG, Stout MJ, Macones GA, Cahill AG. Umbilical Cord Venous Lactate for Predicting Arterial Lactic Acidemia and Neonatal Morbidity at Term. Obstet Gynecol. 2016 Apr;127(4):674-680. doi: 10.1097/AOG.0000000000001339. PMID: 26959212; PMCID: PMC4805460.
8. Yin J, Tian L. Joint confidence region estimation for area under ROC curve and Youden index. Statistics in medicine. 2014;33:985-1000.
9. Wiberg N, Kallen K, Herbst A, Aberg A, Olofsson P. Lactate concentration in umbilical cord blood is gestational age-dependent: a population-based study of 17 867 newborns. BJOG. 2008;115:704-9.
10. Nordström L. Fetal lactate levels during labour and at delivery determined with test strip methods. Stockholm: Karolinska Institute Thesis, 1995. ISBN 916281707-8.
11. Hamed HO. Intrapartum fetal asphyxia: study of umbilical cord blood lactate in relation to fetal heart rate patterns. Arch Gynecol Obstet. 2013 Jun;287:1067-73
12. Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis. BMJ. 2010; 340: c1471.
13. Mokarami P, Wiberg N, Olofsson P. Hidden acidosis: an explanation of acid–base and lactate changes occurring in umbilical cord blood after delayed sampling. BJOG. 2013;120: 996–1002
14. Subramaniam RN. Routine measurements of cord arterial blood lactate levels in infants delivering at term and prediction of neonatal outcome. Med J Malaysia. 2016 jun; 71: 131-3
15. Martin A, Gaillard M, Miot S, Riethmuller D, Schaal JP. Lactate measurements and acid-base balance in cord blood. J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 1):713-9.
16. Geetha Damodaran K, Gilsa ES , Varun S, Menon J, Parvathy R, Veena P. APGAR score and umbilical cord blood levels of Lactate and Creatinine in Perinatal asphyxia. IJBR. 2015;6: 242-5
17. Allanson ER, Pattinson RC, Nathan EA, Dickinson JE. The introduction of umbilical cord lactate measurement and associated neonatal outcomes in a South African tertiary hospital labor ward. J Matern Fetal Neonatal Med. 2017;20: 1-7
Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Copyright (c) 2024 Maria Habib, Maliha Akhtar Qureshi, Irum Sohail