Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace

East, Christine; Leader, Leo R.; Sheehan, Penelope M.; Henshall, Naomi E; Colditz, Paul B.; Lau, Rosalind

doi:10.1002/14651858.cd006174.pub3

Cited by 69 publications

(43 citation statements)

References 49 publications

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“…Although scalp blood lactate measurement requires only a very small amount of blood, this method has not been shown to improve the clinical usefulness compared with scalp blood pH monitoring . Lactate changes correlate well with changes in base excess and it would be interesting to compare the performance of these parameters.…”

Section: Discussionmentioning

confidence: 99%

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Fetal scalp blood sampling in labor – a review

Jørgensen

Weber

2014

Acta Obstet Gynecol Scand

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During the 1970s and 1980s, electronic fetal monitoring and fetal scalp blood sampling were introduced without robust evidence. With a methodical review of the published literature, and using one randomized controlled trial, seven controlled studies, nine randomized studies of various surveillance methods and data from the Danish National Birth Registry, we have assessed the usefulness of fetal scalp blood sampling as a complementary tool to improve the specificity and sensitivity of electronic cardiotocography. Based on heterogeneous studies of modest quality with somewhat inconsistent results, we conclude that fetal scalp blood sampling in conjunction with cardiotocography can reduce the risk of operative delivery. Fetal scalp blood sampling can provide additional information on fetal wellbeing and fetal reserves at a time before decisions are made concerning the need for and timing of operative delivery and the choice of anesthesia, and be an adjunct in the interpretation of cardiotocography patterns.

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Section: Discussionmentioning

confidence: 99%

“…Values between 4.2 and 4.8 are considered intermediate, and values >4.8 mmol require intervention. Fetal monitoring with scalp blood lactate has been compared with pH monitoring, and umbilical cord blood lactate has been shown to correlate well with corresponding pH and base excess values .…”

Section: Introductionmentioning

confidence: 99%

Fetal scalp blood sampling in labor – a review

Jørgensen

Weber

2014

Acta Obstet Gynecol Scand

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“…22 Three units sampled both lactate and pH, although the combined measurement is no better for predicting abnormal neonatal outcome than each method alone. [23][24][25] Umbilical cord blood gas analysis is considered a sensitive indicator of fetal oxygenation and acid-base balance of the infant at birth. 26,27 Some claim the importance of obtaining cord blood gas analysis in risk deliveries, and the Norwegian Society of Gynecology and Obstetrics recommend this.…”

Section: Discussionmentioning

confidence: 99%

National survey of routines for intrapartum fetal monitoring in Norway

Kaasen

Aanstad

Pay

et al. 2018

Acta Obstet Gynecol Scand

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Abbreviations: CTG, cardiotocography; FBS, fetal scalp blood sampling; STAN, ST waveform analysis of fetal electrocardiogram. Abstract Introduction: This study describes clinical routines for intrapartum fetal monitoring in Norway and compliance with national clinical recommendations. Material and methods: A national survey of all (n = 48) birth units in Norway, using a self-reporting questionnaire about fetal monitoring methods and devices available in the birth units, admission cardiotocography (CTG) use, intrapartum fetal monitoring methods for women with and without risk factors, the availability of fetal scalp blood sampling facilities, and umbilical cord blood sampling routines. Results: All birth units responded. They all had access to Pinard stethoscopes, handheld Doppler devices, and CTG. Half of the units used ST waveform analysis (STAN) as an adjunct to CTG. Furthermore, 23 of 48 units analyzed fetal blood samples and 43 of 48 umbilical cord blood gas samples. In 11 units, admission CTG was routinely offered to all women. No units used continuous CTG during labor in low-risk women. However, three units routinely used intermittent CTG during the first stage of labor. Three units used CTG without having access to fetal blood samples or STAN. Conclusions: Our findings indicate some deviations from clinical recommendations in the use of intrapartum fetal monitoring in Norway. Three units used intermittent CTG for women without risk factors. Almost one in four units routinely used admission CTG, despite national clinical recommendations. The lack of access to fetal blood samples or STAN in units using CTG is of concern. K E Y W O R D S admission cardiotocography, cardiotocography, fetal scalp blood sampling, intermittent auscultation, intrapartum fetal monitoring, ST waveform analysis, umbilical cord blood gas analysis

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“…Fetal scalp blood lactate sampling may be a better method of assessing fetal asphyxia as compared to fetal scalp blood pH sampling. 11 Apart from scalp blood sampling, fetal pulse oximetry and fetal electrocardiogram are also interventions that if used in conjunction with CTG may help in a reduction in the high LSCS rate. However, a combination of fetal pulse oximetry with CTG was not found to be effective in reducing the higher incidence of cesarean sections found with CTG alone.…”

Section: Discussionmentioning

confidence: 99%