Suitability of fetal scalp electrodes for monitoring the fetal electrocardiogram during labour

Abstract

As the limitations of heart-rate based intrapartum monitoring have become apparent, there is renewed interest in analysis of the fetal electrocardiographic waveform as obtained from a fetal scalp electrode. A high quality ECG signal is necessary for waveform analysis. This study examined the suitability of five commonly available scalp electrodes for collecting this signal by examining their physical and electrical characteristics, together with a randomised clinical trial in which the ECG trace quality was assessed in 50 patients. The frequency response of Copeland electrodes was such that they attenuate the ECG signal more than the baseline noise. Difficulties were experienced in obtaining optimum attachment and the long, semi-rigid design increased movement artefact resulting in significantly poorer quality ECG signals. Whilst the Hewlett-Packard double spiral electrode had a near ideal frequency response, certain design features made it difficult to apply and remain secure so the clinical signals were of intermediate quality. The Corometrics and Cetro single spirals had the most stable attachment to the scalp and a near ideal frequency response, so produced significantly better signal quality in the clinical trial. Currently, single spiral electrodes are the most suitable for electrocardiographic data collection.