Impact of fetal blood sampling on vaginal delivery and neonatal outcome in deliveries complicated by pathologic fetal heart rate: a population based cohort study
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Werner Stein
, Lars Hellmeyer , Björn Misselwitz and Stephan Schmidt
Abstract
Objective: To compare the impact of electronic fetal monitoring (EFM) alone vs. EFM with additional fetal blood sampling (FBS) in vaginal deliveries complicated by pathologic fetal heart rate (FHR).
Methods: All deliveries in Hesse between 1990 and 2000 were evaluated for participation in this study. Inclusion criteria comprised (1) pathologic fetal heart rate, (2) singleton pregnancy, (3) cephalic presentation, (4) vaginal delivery, and (5) gestational age at delivery of more than 35 weeks' gestation. In order to analyze the meaning of additional risk factors at birth for the effectiveness of FBS two subgroups were selected depending on the presence of additional risk factors at birth. To examine the impact of FBS in deliveries with pathologic FHR on the mode of delivery and on neonatal outcome, univariate regression analysis was performed and odds ratios (OR) and their corresponding 95% confindence intervals (95% CI) were calculated.
Results: The study population comprised 49,560 deliveries, among deliveries complicated by pathologic FHR, 26% underwent FBS. Deliveries with pathologic FHR and controlled by FBS, with no additional antepartum risk factors, were associated with an increase in spontaneous births OR 1.41 (95% CI 1.27–1.58), and in the presence of additional risk factors OR 1.24 (1.19–1.30). Short-term neonatal outcome parameters were characterized by a lower frequency of severe fetal acidosis (umbilical artery pH <7.0) OR 0.55 (0.42–0.72), and Apgar score <5 after 5 min, OR 0.71 (0.55–0.90).
Conclusion: In vaginal deliveries with pathologic FHR the use of FBS as an additional means of intrapartum fetal surveillance is associated with less vaginal operative deliveries, and with an improved short-term neonatal outcome.
References
1 ACGO, Amercian College of Obstetrics and Gynecology: Fetalheart rate patterns: monitoring, interpretation, and management. ACOG technical bulletin. No 207. J Gynaecol Obstet 51 (1995) 65Search in Google Scholar
2 Ayromlooi J, R Garfinkel: Impact of fetal scalp blood pH on the incidence of cesarean section performed for fetal distress. Int J Gynaecol Obstet17 (1980) 391Search in Google Scholar
3 Bakker PC, GJ Colenbrander, AA Verstraeten, HP Van Geijn: The quality of intrapartum fetal heart rate monitoring. Eur J Obstet Gynecol Reprod Biol116 (2004) 22Search in Google Scholar
4 Berkus MD, O Langer, A Samueloff, EMJ Xenakis, NT Field: Electronic fetal monitoring: what's reassuring. Acta Obstet Gynecol Scand78 (1999) 15Search in Google Scholar
5 Brandt-Niebelschutz S, E Saling: Indications for operative termination of labor on cardiotocography and fetal blood analysis: the reliability of these methods. J Perinat Med22(1994) 1910.1515/jpme.1994.22.1.19Search in Google Scholar
6 Brown VA, RS Sawers, RJ Parsons, SLB Duancan, ID Cooke: The value of antenatal cardiotocography in the management of high risk pregnancy: a randomized controlled trial. Br J Obstet Gynaecol89 (1982) 716Search in Google Scholar
7 Clark SL, RH Paul: Intrapartum fetal surveillance: the role of fetal scalp blood sampling. Am J Obstet Gynecol153 (1985) 717Search in Google Scholar
8 Dervaitis KL, M Poole, G Schmidt, D Penava, R Natale, Gagnon R: ST segment analysis of the fetal electrocardiogram plus electronic fetal heart rate monitoring in labor and its relationship to umbilical cord arterial blood gases. Am J Obstet Gynecol191 (2004) 879Search in Google Scholar
9 Donald W, MD Thibeault, K Frederick, DO Hall, B Michael, MD Sheehan, et al.: Postasphyxial lung disease in newborn infants with severe perinatal acidosis. Am J Obstet Gynecol150 (1984) 393Search in Google Scholar
10 Dudenhausen JW, C Luhr, JS Dimer: Umbilical artery blood gases in healthy term newborn infants. Inter J Gynecol Obstet57 (1999) 251Search in Google Scholar
11 Gardosi J, News FIGO: Intrapartum surveillance: recommendations on current practice and overview of new developments. Int J GynecolObstet (1995) 21310.1016/0020-7292(95)90308-9Search in Google Scholar
12 Garite TJ, GA Dildy, H McNamara: A multicenter controlled trial of fetal pulse oximetry in the intrapartum management of non reassuring fetal heart rate patterns. Am J Obstet Gynecol183 (2000) 1049Search in Google Scholar
13 Graham ID, J Logan, B Davies, C Nimrod: Changing the use of fetal monitoring and labor support: a case study of barriers and facilitators. Birth31 (2004) 293Search in Google Scholar
14 Goodwin TM, L Milner-Masterson, PH Paul: Elimination of fetal scalp blood sampling on a large clinical service. Obstet Gynecol83 (1994) 971Search in Google Scholar
15 Haverkamp AD, M Orleans, S Langendoerfer: A controlled trial of the differential effect of intrapartum fetal monitoring. Am J Obstet Gynecol134 (1979) 399Search in Google Scholar
16 Kühnert M, S Schmidt: Intrapartum management of nonreassuring fetal heart rate patterns: a randomized controlled trial of fetal pulse oximetry. Am J Obstet Gynecol191 (2004) 1989Search in Google Scholar
17 Künzel W: The birth survey in Germany—education and quality control in perinatology. Eur J Obstet Gynecol Reprod Biol54 (1994) 1310.1016/0028-2243(94)90075-2Search in Google Scholar
18 Low JA, V Rahi, EJ Derrick: Predictive value of electronic fetal monitoring for intrapartum fetal asphyxia with metabolic acidosis. Obstet Gynecol93 (1999) 285Search in Google Scholar
19 McDonald D, A Grant, M Sheridan-Pereira: The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring. Am J Obstet Gynecol152 (1985) 524Search in Google Scholar
20 Morris ED, Beard RW: The rationale and technique of foetal blood sampling and Amnioscopie. J Obstet Gynaecol Br Commonw72 (1965) 489Search in Google Scholar
21 Nelson KB: The neurologically impaired child and alleged malpractice at birth. Neural Clin17 (1999) 28310.1016/S0733-8619(05)70131-6Search in Google Scholar
22 Palomaki O, M Jansson, H Huhtala, P Kirkinen: Severe cardiotokographic pathology at labor: effect of acute intravenous tocolysis. Am J Perinatol21 (2004) 347Search in Google Scholar
23 Parer JT: The current role of intrapartum fetal blood sampling. Clin Obstet Gynecol23 (1980) 56510.1097/00003081-198006000-00025Search in Google Scholar PubMed
24 Parer JT: Obstetric technologies: What determines clinical acceptance or rejection of results of randomized controlled trials? Am J Obstet Gynecol188 (2003) 162210.1067/mob.2003.394Search in Google Scholar PubMed
25 Priddy KD: Is there logic behind fetal monitoring? J Obstet Gynecol Neonatal Nurs33 (2004) 55010.1177/0884217504268942Search in Google Scholar PubMed
26 Renou P, A Chang, I Anderson: Controlled trial of fetal intensive care. Am J Obstet Gynecol126 (1976) 470Search in Google Scholar
27 Rooth G, Huch A, Huch R: Guidelines for the use of fetal monitoring. Int J Gynecol Obstet25 (1987) 159Search in Google Scholar
28 Royal College of Obstetricians and Gynaecologists. The use of Electronic Fetal Monitoring. RCOG Press, May 2001Search in Google Scholar
29 Saling E: [Technic for the endoscopic Micro-sampling of Blood from the Fetus.] [Article in German] Geburtshilfe Frauenheilkd24 (1964) 464Search in Google Scholar
30 Saling E: Amnioscopy and foetal blood sampling: observations on foetal acidosis. Arch Dis Child41 (1966) 47210.1136/adc.41.219.472Search in Google Scholar PubMed PubMed Central
31 Schneider D, H Stockhammer, E Hochuli: [Blood microanalysis on the endangered fetus.] [Article in German] Arch Gynakol204 (1967) 245Search in Google Scholar
32 Schneider KTM, M Butterwegge, M Daumer, J Dudenhausen, A Feige, M Gonser, et al.: Anwendung des CTG waehrend Schwangerschaft und Geburt. DGGG 2004 Leitlinienverzeichnis Nr. 4.5.1.3. Frauenarzt45 (2004) 979Search in Google Scholar
33 Schmidt S, B Misselwitz, W Künzel: Does fetal blood sampling improve fetal surveillance? Geburtsh Frauenheilk65 (2005) 368Search in Google Scholar
34 Spencer JA: Clinical overview of cardiotocography. Br J Obstet Gynaecol100 (1993) 410.1111/j.1471-0528.1993.tb10626.xSearch in Google Scholar PubMed
35 Steer PJ, P Danielian: Fetal distress in labour. In: James DK, CP Weiner, B Gonik (ed). High risk pregnancy management options. London, WB Saunders 1999Search in Google Scholar
36 Thacker SB, D Stroup, M Chang: Continuous electronic heart rate monitoring for fetal assessment during labor (Cochrane Review). In: The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiley & Sons, LtdSearch in Google Scholar
37 Zalar RW Jr, EJ Quilligan: The influence of scalp sampling on the cesarean section rate for fetal distress. Am J Obstet Gynecol135 (1979) 239Search in Google Scholar
©2006 by Walter de Gruyter Berlin New York
Articles in the same Issue
- WAPM-Newsletter No 2/2006 ACTIVITIES OF THE “INTERNATIONAL ACADEMY OF PERINATAL MEDICINE”
- Editorial
- Neurosonography in the second half of fetal life: a neonatologist's point of view
- Normal and abnormal transformation of the spiral arteries during pregnancy
- Lessons learned from maternal deaths at an East African health center
- Maternal venous procalcitonin levels do not correlate with umbilical cord blood and venous blood concentrations in the neonate
- Increased cortisol concentrations in the cord blood of newborns whose mothers smoked during pregnancy
- The assessment of fetal behavior of growth restricted fetuses by 4D sonography
- Impact of fetal blood sampling on vaginal delivery and neonatal outcome in deliveries complicated by pathologic fetal heart rate: a population based cohort study
- Postnatal growth failure in preterm infants: ascertainment and relation to long-term outcome
- Impact of breast-feeding on psychomotor and neuropsychological development in children of diabetic mothers: role of the late neonatal period
- Factors associated with hypospadias in Asian newborn babies
- Spontaneous dichorionic triamniotic triplet pregnancy affected by TTTS: follow-up from diagnosis to three months of extrauterine life
- Antibiotic therapy for preterm premature rupture of membranes
- Reply
- Delivery of a healthy child 30 weeks after resuscitation for thromboembolism and treatment with danaparoid: 5-year follow up
- Seasonality of birth and acute lymphoblastic leukemia
- Errata
- Congress Calendar
- Index Volume 34 (2006)
- Index - Subjects
- Index - Authors
- Acknowledgement
Articles in the same Issue
- WAPM-Newsletter No 2/2006 ACTIVITIES OF THE “INTERNATIONAL ACADEMY OF PERINATAL MEDICINE”
- Editorial
- Neurosonography in the second half of fetal life: a neonatologist's point of view
- Normal and abnormal transformation of the spiral arteries during pregnancy
- Lessons learned from maternal deaths at an East African health center
- Maternal venous procalcitonin levels do not correlate with umbilical cord blood and venous blood concentrations in the neonate
- Increased cortisol concentrations in the cord blood of newborns whose mothers smoked during pregnancy
- The assessment of fetal behavior of growth restricted fetuses by 4D sonography
- Impact of fetal blood sampling on vaginal delivery and neonatal outcome in deliveries complicated by pathologic fetal heart rate: a population based cohort study
- Postnatal growth failure in preterm infants: ascertainment and relation to long-term outcome
- Impact of breast-feeding on psychomotor and neuropsychological development in children of diabetic mothers: role of the late neonatal period
- Factors associated with hypospadias in Asian newborn babies
- Spontaneous dichorionic triamniotic triplet pregnancy affected by TTTS: follow-up from diagnosis to three months of extrauterine life
- Antibiotic therapy for preterm premature rupture of membranes
- Reply
- Delivery of a healthy child 30 weeks after resuscitation for thromboembolism and treatment with danaparoid: 5-year follow up
- Seasonality of birth and acute lymphoblastic leukemia
- Errata
- Congress Calendar
- Index Volume 34 (2006)
- Index - Subjects
- Index - Authors
- Acknowledgement