The benefit of sampling the lactate levels in umbilical cord artery after birth to provide information to doctors and nurses about care in labour and improve future practice.

All midwives and registrars in the unit underwent a training course in fetal physiology, lactate physiology and cardiotocograph (CTG) interpretation, conducted by the primary researcher (EA). The course consisted of a pre-test, a series of didactic lectures, interactive application of knowledge with CTG examples, and a post-test. The course was an intensive half a day course. The pre-test consisted of 20 multiple choice questions. Then 3 hour long lectures were given; on fetal physiology, fetal acid base status, and CTG pattern recognition. A 36 questionairre post test was then delivered. It was a requirement of the unit that all doctors and midwifes complete the training. Subsequently umbilical artery lactate sampling occurred, with the results made immediately available to the clinicians managing the intrapartum care of women in the labour ward. Lactate samples were obtained by (after maternal consent was obtained): the umbilical cord was clamped and cut within one minute of birth. A small arterial blood sample (<0.5uL) was then taken from a double clamped segment of the remaining umbilical cord, prior to delivery of the placenta. The lactate level was measured (mmol/L) on a Roche Accutrend PlusTM© hand-held lactate meter (Rotkreuz, Switzerland). The coefficient of variation (CV) for this lactate meter is 1.8-3%. Furthermore, all lactate samples obtained in the previous 24 hours were reviewed at the daily morning labour ward meetings of all medical staff (interns, registrars, and consultants), and twice weekly, an in-depth review of interesting or challenging cases was facilitated by the primary researcher (EA). Daily reviews involved correlating CTG interpretation pre-delivery with neonatal outcomes, including the UA lactate. During the two study periods, basic data on all deliveries (regardless of recruitment to the study) were collected, including number of deliveries, mode of deliveries, and admissions to the neonatal nursery (all levels).