Effectiveness of fetal scalp stimulation test in assessing fetal wellbeing during labor, a retrospective cohort study

Sporadic accelerations during labor strongly indicate normal pH, whereas periodic accelerations do not: a case-control study

PURPOSE

To determine the association between the occurrence of sporadic and periodic fetal heart rate accelerations during labor and acidemia at birth.

MATERIALS AND METHODS

This is a case-control study of fetal heart rate patterns from 364 neonates with acidemia at birth (cord blood pH <7.05 at vaginal birth, or pH <7.10 at birth after first stage cesarean delivery) and 731 controls with pH ≥7.15. The last 30-60 min of the cardiotocographic traces before birth from the neonates born with acidemia and from the corresponding stage in labor for the controls were scrutinized. Odds ratios (OR) with 95% confidence interval for acidemia at birth were determined.

RESULTS

During the first stage, ≥2 sporadic accelerations were present in 16% of cases and 78% of controls; OR for acidemia (compared to 0-1 accelerations) 0.05 (0.02-0.10). In the second stage, the corresponding rates were 13% and 60%, OR 0.09 (0.06-0.14). Isolated periodic accelerations were infrequent. A weak negative association between ≥2 periodic accelerations and acidemia (compared with 0-1 accelerations) was found in the second stage, OR 0.51 (0.30-0.86), but was not significant in the first stage, OR 0.24 (0.04-1.4). Even among fetuses with normal fetal heart rate variability (5-25 beats per minute) the occurrence of less than two sporadic accelerations was associated with an increased risk of acidemia, OR 10.3 (7.2-14.8).

CONCLUSIONS

Sporadic accelerations indicate a very low probability of acidosis but are absent in 40% of fetuses with normal pH during a 30-60 min second-stage recording.

MANUAL FETAL STIMULATION DURING INTRAPARTUM FETAL SURVEILLANCE: A RANDOMISED CONTROLLED TRIAL: CharacteristicMaternal outcome

BACKGROUND

Manual fetal stimulation, either by mechanical manipulation or by stimulation of the fetal scalp is known to evoke a fetal heart response in a normal fetus.

OBJECTIVES

To assess the clinical effectiveness of manual fetal stimulation in assessment of fetal well-being during labor compared with no stimulation among women with a singleton pregnancy. To study the maternal and neonatal outcomes in the two groups.

STUDY DESIGN

A randomized controlled trial undertaken in the department of Obstetrics and Gynecology at a tertiary care teaching hospital between 2014 and 2016.

INCLUSION CRITERIA

Women with a singleton pregnancy at or after 37 weeks of gestation with cephalic presentation in labor having one of the following abnormalities on fetal heart tracing - fetal heart rate less than 110 beats per minute or more than 160 beats per minute, variable decelerations, late decelerations, minimal or absent beat to beat variability.

EXCLUSION CRITERIA

women requiring an immediate cesarean section; conditions which would preclude a vaginal delivery; intrauterine fetal demise or a major fetal congenital abnormality. The women were followed in labor and randomised to either the manual stimulation group or the no stimulation group when one of the CTG abnormalities were present. In the manual stimulation group the fetus was stimulated, abdominally by holding the head in the palm of one hand when the cervical dilatation was less than 3cm or vaginally by pinching the scalp of the fetus when the cervical dilatation was ≥3cm. After delivery, cord blood sample was collected and pH estimated. Mother and baby were followed up until discharge and mode of delivery, cord blood pH at birth, Apgar score at 1 and 5 minutes, neonatal intensive care unit admissions and duration of stay were the outcomes studied. Data was entered and compiled as frequency and percent for categorical variables. For continuous variables, data was calculated using mean and standard deviation. Chi-square test was used for assessing the association between the intervention and fetal and maternal outcomes.

RESULTS

A total of 327 women were included in the trial, of whom 164 were in the manual fetal stimulation group (group 1) and 163 were in the 'no stimulation' group (group 2). The Cesarean section rates were 25.61% in group 1 and 30.67% in group 2 (p=0.308). The mean cord blood pH at birth was 7.267±0.027 in group 1 and 7.265±0.024 in group 2 (p=0.479)and Apgar score at 1 min and 5 min (p=0.169 and p=0.423 respectively between the two groups) were not found to be statistically different among the two groups.

CONCLUSION

There is no significant change in feto-maternal outcomes with manual fetal stimulation in women having non-reassuring cardiotocographic changes in labor.