New Test for C Section Risk

A new test has been developed in Sweden, which could predict if women in labor hoping for a vaginal birth will in fact end up having a c section birth.

Researchers at Liverpool University and Liverpool womens hospital have established that when high levels of lactic acid are measured in the amniotic fluid, it is unlikely the mother will deliver vaginally. Based on this research the test was developed by the Swedish company Obstecare.

Measuring lactic acid could help decide whether to end what could prove to be a long and difficult labor and opt for a Cesarean earlier. Prolonged labors of this kind, which end up resulting in a Caesarean section are seen by many as the worst of all worlds. Man y mothers end up with a feeling of failure, and babies can become distressed and at risk.

The test is being rolled out in a number of European hospitals.

Their studies showed that the uterus produces lactic acid as other muscles do when they work hard, but that when it reaches a certain level the substance starts to inhibit contractions.

The test works by measuring the amount of lactic acid present in the amniotic fluid. The research found that high concentrations of lactic acid in the amniotic fluid of laboring women were associated with a significantly increased risk of emergency c section. Women whose lactic acid levels were low were more likely to have a spontaneous vaginal birth.

During an arrested labor, attempts are often made to stimulate the uterus with an oxytocin infusion. The research shows that if there is a high level of lactic acid present, this indicates the uterus will be unlikely to be able to complete the delivery. If the levels of lactic acid are low, this suggests that the uterus is capable of producing the contractions that are required to birth the baby.

Johan Ubby of Obstecare says the test should help doctors establish which women may go on to deliver vaginally, as low levels of lactic acid suggest the uterus could still produce the contractions needed to push out the baby.

“But a high level of lactic acid in the 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 metres after he or she has passed the finish line.”

He says the system of testing, which has already started in hospitals in Sweden, Norway and Belgium, should reduce the number of Cesareans for women who may not need them and accelerate them for those that do to “avoid the risk of complications from a long birth and limit unnecessary suffering”.

Professor Donald Peebles, a spokesman for the Royal College of Obstetricians and Gyneacologists and consultant at University College, London, described the test as a “nice idea”.

“I can definitely see the logic, and it would be straightforward to carry out. I would be interested in seeing a large prospective study where you could see the impact it had on the management of labor and whether overall outcomes were improved.”

Professor Susan Wray of the Center for Better Births added that one next step would be to work out how to “wash away” the acid which appears to inhibit labor.

The debate over the reason for, and use of c sections in labor, and elective c sections in particular, continues. But most will agree that a long and painful labor, ending in an emergency c section at the point at which the health of the mother and baby are compromised, is undesirable for everyone. Hopefully these new tests will aid doctors in helping mothers and babies to avoid this, and will result in more positive birth experiences.

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