Start Submission Become a Reviewer

Reading: Fetal scalp stimulation tests to improve the value of an admission cardiotocograph

Download

A- A+
dyslexia friendly

Research Article

Fetal scalp stimulation tests to improve the value of an admission cardiotocograph

Authors:

K. A. U. S. Kumarapperuma ,

Base Hospital,Udugama, LK
About K. A. U. S.
Acting consultant Obstetrician and Gynaecologist
X close

I. M. R. Goonewardene

Faculty of Medicine, Galle, LK
About I. M. R.
Professor of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology
X close

Abstract

Introduction: An admission cardiotocograph (CTG) in a woman in early labour can lead to unnecessary interventions without improving neonatal outcomes

 

Objective: To assess fetal scalp stimulation as a complementary test to improve the value of an admission CTG.

 

Method: Women (n = 243) with uncomplicated singleton pregnancies with a cephalic presentation at >37 weeks gestation, in early labour or with induction of labour (IOL )) had a CTG for ten minutes followed by a fetal scalp Digital Stimulation Test (DST) for 15 seconds during the routine vaginal examination, and the CTG was continued for another five minutes. If fetal heart rate (FHR) acceleration were absent after DST ( DST negative) , an Allis Clamp was applied to the fetal scalp and the CTG was continued for another five minutes. FHR accelerations indicated a positive test result. The initial CTG and the results of DST and application of Allis Clamp were compared with the five-minute APGAR score of the neonate.

 

Results: Of the 243 women, 107 (44%) had a negative DST but this number decreased to 27 (11%) after additional Allis clamping of the fetal scalp. The addition of the fetal scalp stimulation tests (FSST) markedly increased the specificity of the CTG in predicting neonatal hypoxia from 58% (95% CI 51.3-64.6%) to 96.4% (95% CI 93-98.5%). After the addition of FSST , the likelihood ratio of the presence of FHR accelerations in excluding neonatal hypoxia was 22.1 ( 95% CI 10.8-45.4) while the likelihood ratio of the absence of FHR accelerations in predicting neonatal hypoxia was 0.22 (95% CI 0.1-0.52)

 

Conclusion: When FHR accelerations are absent in the admission CTG, FSST complement it by helping to rule out fetuses probably not having hypoxia during early labour or IOL, and enables the identification of fetuses who would require close monitoring.
How to Cite: Kumarapperuma, K.A.U.S. & Goonewardene, I.M.R., (2016). Fetal scalp stimulation tests to improve the value of an admission cardiotocograph. Sri Lanka Journal of Obstetrics and Gynaecology. 38(3), pp.49–53. DOI: http://doi.org/10.4038/sljog.v38i3.7799
Published on 01 Dec 2016.
Peer Reviewed

Downloads

  • PDF (EN)

    comments powered by Disqus