{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:00:34Z","timestamp":1785517234147,"version":"3.56.0"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n Since 60\u2009years, pH measurement in fetal scalp blood samples (FBS) is used to diagnose fetal hypoxia during labor, although the last three decades lactate measurement in FBS has been increasingly used as a safe alternative with a lower chance of failure. However, studies demonstrating the direct relation between lactate and pH in FBS with the currently used measurement systems are lacking. Therefore, clinical acceptance and implementation is impeded. This study investigated the relation between lactate and pH in FBS and derived an appropriate lactate cutoff value.<\/jats:p>\n <\/jats:sec>\n \n Material and Methods<\/jats:title>\n This observational prospective single\u2010center study included 263 FBS in the period of 8 months. After collection of FBS, pH was assessed first (iSTAT\u00ae), after which lactate was assessed (StatStrip\u00ae Lactate 2). Clinical decisions were based on pH results only. Our primary objective was to assess the correlation between lactate and pH in FBS and to establish a lactate cutoff value for ruling out a low Apgar score at 5 minutes and neonatal acidosis, with corresponding sensitivity and specificity as secondary outcomes. Diagnostic performance of lactate was assessed by using the area under the curve (AUC) of the receiver operation characteristic curve (ROC curve), from which cutoff values were derived.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In FBS, lactate and pH showed a moderate inverse linear correlation (\n r<\/jats:italic>\n \u2009=\u2009\u22120.53). The AUC of the ROC curve was 0.88 (0.83\u20130.93), indicating a good diagnostic performance of lactate to identify an abnormal pH (pH\u2009<7.20 in FBS). A cutoff value for lactate of \u22655.6\u2009mmol\/L seemed to have the most optimal balance between sensitivity (78.1% [60.0\u201390.7%]) and specificity (79.2% [73.4\u201384.3%]) for a pH\u2009<7.20 in FBS.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study confirmed that the StatStrip\u00ae Lactate 2 is a suitable alternative analyzer for measurement of lactate compared with measurement of pH with the iSTAT in FBS. Despite only a moderate correlation between lactate and pH, a lactate cutoff value of \u22655.6\u2009mmol\/L could be proposed for clinical decision\u2010making. This knowledge increased confidence of our gynecologists in this relatively new method and paved the way for successful and universal implementation of lactate in FBS, eventually without measuring pH.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/aogs.70329","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T16:11:32Z","timestamp":1785514292000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Toward implementation of lactate compared with\n pH<\/scp>\n in fetal scalp blood sampling during labor: A clinical comparative single\u2010center study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9457-3760","authenticated-orcid":false,"given":"Suzanne J.","family":"van Woudenberg","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Utrecht The Netherlands"},{"name":"Department of Obstetrics and Gynaecology Arnhem The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivonne","family":"Mijnheer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arnhem The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel M. 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J.","family":"van Borren","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry Arnhem The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3289-2512","authenticated-orcid":false,"given":"Lian","family":"Roovers","sequence":"additional","affiliation":[{"name":"Clinical Research Center Arnhem The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Femi","family":"Janse","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arnhem The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"Fetal monitoring in labour \u2010 NICE guidelines.2025.https:\/\/www.nice.org.uk\/guidance\/ng229"},{"key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.ijgo.2015.06.020","article-title":"FIGO consensus guidelines on intrapartum fetal monitoring: cardiotocography","volume":"131","author":"Ayres\u2010de\u2010Campos D","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"key":"e_1_2_13_4_1","unstructured":"NVOG richtlijn \u2010 intrapatrum foetale bewaking \u00e0 terme.2025.https:\/\/www.nvog.nl\/wp\u2010content\/uploads\/2018\/02\/Foetale\u2010bewaking\u20103.0\u201014\u201011\u20102013.pdf"},{"key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1111\/aogs.12416","article-title":"Fetal scalp blood sampling during labor: an appraisal of the physiological basis and scientific evidence","volume":"93","author":"Chandraharan E","year":"2014","journal-title":"Acta Obstet Gynecol Scand"},{"key":"e_1_2_13_6_1","article-title":"Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non\u2010reassuring fetal heart rate trace","volume":"2015","author":"East CE","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.bpobgyn.2015.05.006","article-title":"Foetal scalp blood sampling during labour for pH and lactate measurements","volume":"30","author":"Carbonne B","year":"2016","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"e_1_2_13_8_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jogoh.2025.102991","article-title":"Should fetal blood sampling still be a part of monitoring during labor in the modern era?","volume":"54","author":"Garabedian C","year":"2025","journal-title":"J Gynecol Obstet Hum Reprod"},{"key":"e_1_2_13_9_1","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/j.1471-0528.1998.tb09346.x","article-title":"Lactate compared with pH analysis at fetal scalp blood sampling \u2010 a prospective randomised study","volume":"105","author":"Westgren M","year":"1998","journal-title":"Br J Obstet Gynaecol"},{"key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1136\/bmj.39553.406991.25","article-title":"Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress: randomised controlled multicentre trial","volume":"336","author":"Wiberg\u2010Itzel E","year":"2008","journal-title":"BMJ"},{"key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/S0002-9378(16)33082-4","article-title":"A controlled trial of the differential effects of intrapartum fetal monitoring","volume":"134","author":"Haverkamp AD","year":"1979","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_13_12_1","first-page":"351","article-title":"Cardiotocography supplemented with continuous fetal pH monitoring during labor. 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