Improve treatment of dystocia

An obstetrician and midwife is often faced with a situation where the progress of labor has been arrested and the Action Line in the partogram has been passed. Many of these child births will result in normal vaginal deliveries. However, there is a significant number of these women who will go through a long, painful, parturition that will ultimately end in a caesarean, ventouse or forceps delivery.

In this situation, the appropriate action is often decided under the pressure of time. A normal vaginal delivery is the preferred option, while a prolonged labor will put heavy strain on both the fetus and the mother. This can lead to complications such as Postpartum Haemorrhage or fetal asphyxia.

If the membranes are already ruptured, the current standard management for dysfunctional labor is oxytocin infusion. However it is well known that oxytocin might be ineffective in many situations, and does not significantly reduce the caesarean rate.

Scientific background
One of the most important risk factors for dystocic delivery is an inefficient and long-lasting muscle activity that may lead to muscle hypoxia with progressive lactic acidosis in the myometrium. By combining the information of labour progress together with measurement of lactic acid concentration in the amniotic fluid (AFL-test) a new and more precise decision tool for monitoring the delivering mother can be obtained.

Numerous both experimental and clinical studies have shown that high levels of AFL correlate to both instrumental deliveries and caesarean section, often after a very long and extended labour progress. One of the main reasons is assumed to be the accumulation of lactate acid in the myometrium during contractions that reduces the strength of the remaining contractions and contributes to poor delivery outcome. There is also substantial evidence that an overuse/misuse of Oxytocin in these situations can lead to even further increased AFL levels.

Data from studies also clearly show that a substantial part of women who have arrested labour still will have a low AFL level. If these deliveries are handled in a proper way most of them will have a normal and vaginal outcome. These women usually respond favourably to Oxytocin infusion.

AFL® monitoring
For the first time we have a tool, to support a correct clinical decision, in the above described clinical situation. A high level of lactate in amniotic fluid indicates that the uterus is exhausted. To stimulate this kind of labor with an oxytocin infusion would be like asking a marathon runner to run an extra 10,000 meters after she or he has passed the finish line.

By measuring AFL® (Amniotic Fluid Lactate level) in an arrested or slow progressing labor, you will have a better understanding of the situation and better guide of how to proceed. By individualising oxytocin infusion based on the AFL level an unnecessary operative delivery can be avoided

A normal level of AFL®, even if the labour is arrested, is a strong indication that using oxytocin according to normal treatment protocols will result in a spontaneous vaginal delivery.

On the other hand, a high level of AFL® is a strong indication that using oxytocin will not improve the probability for a spontaneous vaginal delivery and that the delivery will end in operative intervention. However, if high AFL® levels are avoided or appropriately taken care of during active labor, the probability for a spontaneous vaginal delivery is increased and an unnecessarily operative delivery may be avoided.

By measuring AFL® (Amniotic Fluid Lactate level) in a slow progressing labor, you will have a better understanding of the situation and better guide of how to proceed.