Abstract:
BACKGROUND : Of the 5.54 million stillbirths and neonatal deaths occurring globally each year, a significant amount
of these occur in the setting of inadequate intrapartum care. The introduction of universal umbilical artery lactate
(UA) measurements in this setting may improve outcomes by providing an objective measurement of quality of
care and stimulating case reflection, audit, and practice change. It is important that consideration is given to the
barriers and facilitators to implementing this tool outside of a research setting.
METHODS : During the period 16/11/2014 -13/01/2015, we conducted a training course in cardiotocograph (CTG)
interpretation, fetal physiology, and the sampling and analysing of UA lactate, with a pre and post questionnaire
aimed at assessing the barriers and facilitators to the introduction of universal UA lactate in a district hospital in the
Eastern Cape, South Africa.
RESULTS : Thirty-five pre-training questionnaires available (overall response rate 95 %) and 22 post training questionnaires
(response rate 63 %) were available for analysis. Prior to training, the majority gave positive responses (strongly agree or
agree) that measuring UA lactate assists neonatal care, is protective for staff medicolegally, and improves opportunities
for audit and teaching of maternity practice (n = 33, 30, 32; 94.4 %, 85.7 %, 91.4 % respectively). Respondents remained
positive about the benefits post training. An increased workload on medical or midwifery staff was less likely to be seen
as barrier following training (71 vs. 38.9 % positive response, p = 0.038). A higher rate of respondents felt that expense
and lack of equipment were likely to be barriers after completing training, although this wasn’t significant. There was a
trend towards lack of time and expertise being less likely to be seen as barriers post training.
CONCLUSION : The majority of participants providing intrapartum care in this setting are positive about the role of
universal UA lactate analysis and the potential benefits it provides. Training aids in overcoming some of the perceived
barriers to implementation of universal UA lactate analysis.
