Fetal monitoring in labor: Are accelerations good enough?

Abstract

Objective. To investigate whether accelerations of the fetal heart rate in response to scalp stimulation (the scalp stimulation test) before fetal scalp blood sampling (FBS) are such a good predictor of fetal well-being as to render the FBS unnecessary.Methods. A retrospective observational study. Cardiotocograms (CTG) from 54 fetuses during labor in whom 70 FBS procedures were performed, were analysed by an investigator blinded to the outcome, to determine whether accelerations were present in response to fetal scalp stimulation during vaginal examination (VE) prior to the FBS. This was compared with the pH obtained at FBS in a 2×2 table. The primary outcome measure was the false negative rate of the scalp stimulation test.Results. There were accelerations at 48 VEs before FBS (n = 70). In five cases there was fetal acidosis (pH ⩽ 7.20). Three of these five fetuses had accelerations at VE, giving a false negative rate of 6.25%.Conclusion. These data do not support previous reports that accelerations in response to fetal scalp stimulation before FBS exclude fetal acidosis when the CTG is suspicious and FBS is otherwise indicated. A larger sample may help answer this question.