74:
complicated pregnancies, it is recommended that there is continuous monitoring of the baby's heart rate using an electronic recorder, or CTG. During labor, babies can show abnormal readings on the CTG and, in some cases, this warrants an emergency caesarean section. To avoid this emergency C-section, the baby's scalp is stimulated vaginally to cause an increase in heart rate. This response is indicative that the baby is healthy and receiving enough oxygen and this test also provides a safe alternative as opposed to taking a small blood sample from the baby's scalp and testing the acid-base levels in the blood. This test is beneficial because it reduces the need to have to perform an emergency C-section when it may not be needed.
122:. The two different types of fetal acidosis are respiratory acidosis or metabolic acidosis. Respiratory acidosis occurs when carbon dioxide accumulates due to decreased placental elimination. This is caused by an increase in pressure on the umbilical cord, but is quickly corrected upon childbirth as carbon dioxide levels return to normal once the baby begins breathing. Metabolic acidosis is caused by anaerobic cell metabolism due to hypoxia. Anaerobic metabolism results in the production of lactate, which breaks down and lowers blood pH. Even after correction, metabolic acidosis can persist for several hours before correction after childbirth.
146:
Based on clinical literature, there has been discordance between scalp pH and lactate measurements, especially when the cervix was fully dilated. Using lactate values rather than pH or both could result in an increase in obstetric interventions without decreasing severe acidosis. Fetal scalp lactate measurements also require a much smaller volume of blood whereas fetal blood sampling is more invasive. A smaller volume of blood is required for testing of fetal blood sampling for lactate estimation. This test can help determine an abnormal fetal heart rate pattern. Also, this test requires a smaller volume of blood compared to a pH estimation.
53:
abnormalities, identify fetal infections, fetal anemia, and low platelet count. With the help of continuous ultrasound guidance to place the needle in the abdomen into the tiny fetal blood vessel, the blood sample gets obtained and sent for testing. Therefore, due to limitation in adding value, fetal scalp testing can serve as second line test to provide and strengthen the information on fetal acidosis and hypoxia status obtained from
204:
oxygenation deficiency. The advantages of lactate measurement is that it is required 5 ÎŒl of fetal blood for analysis and provided immediate results compared to pH scalp testing. One of the observational studies suggested that a threshold of 4.8 mmol/L of lactate scalp measurement was chosen to prevent acidemia in newborns, which is corresponding to fetal scalp pH of 7.21.
217:
scalp of the fetus, but instead acts as a indirect measurement of fetal blood pH status by measuring oxygen saturation. Furthermore, studies are being done to evaluate and compare between the fetal scalp blood test and digital fetal scalp blood test, an alternative to fetal scalp blood test that is less invasive, as a second-line test for fetal hypoxia and acid-base status.
49:
cord, abnormal fetal heartbeat and abnormal coloration of amniotic fluid. This correlation can only be concluded by sampling fetal scalp blood and measuring acid status. Therefore, fetal scalp blood testing could be used to reduce the number of unnecessary emergency caesarean sections made on the decision of fetal heart rate alone.
87:
complications have also been reported including infection, excessive bleeding, and leakage of cerebral spinal fluid. Fetal scalp blood testing should be avoided when there is a potential risk of infection (e.g. HIV, Hepatitis B, Hepatitis C) or any suspicions of rare bleeding disorders in newborns, known as
216:
Improvements to the fetal blood scalp test procedure have been attempted to decrease invasiveness. Researchers have created a portable oximeter device which attaches to the hand of a physician and allows for the measurement of fetal oxygenation status. This method does not require blood draw from the
82:
During a fetal scalp blood testing procedure, a small incision on the fetal scalp is made and blood is collected using a capillary tube. An amnioscope with a light source is used to expose the scalp of the fetus, and the procedure requires at least 3 to 4 cm of cervical dilation to visualize the
199:
During pregnancy, placental gas-exchange is primarily responsible for fetus well-being. Placental dysfunction can results in fetal risks such as acidosis, hypoxia, and stillbirth. The normal arterial pH of the fetus is approximately 7.35 before labor. Furthermore, there is a declined in pH which has
60:
Fetal blood sampling is a complex procedure and performed when other tests are not possible. It can be done for pregnancies that are 18 weeks or later. The procedure has many benefits such as providing specific information about the baby's health and the ability to treat babies with any severe blood
48:
has occurred following fetal cardiac distress. While continuous fetal heart rate monitoring is the primary method for assessing fetal wellbeing during labor, a change in fetal heart rate is not indicative of fetal acidemia. Some of the signs and symptoms of oxygen deprivation are pH in the umbilical
145:
in predicting umbilical artery acidemia. Analysis of pH requires a relatively large amount of blood (30â50 ÎŒl), and sampling failure rates of 11â20% have been reported. Analysis of lactate only requires 5 ÎŒl of blood and can more accurately identify the cause of acidosis if metabolically induced.
69:
The use of fetal scalp blood testing originated in
Germany in 1961 and required 0.25 mL of blood drawn from the fetus. As one of the first methods of monitoring fetal wellbeing during labor, there were many disadvantages including the need for at least 3 cm dilation of the mother and extreme
203:
Fetal scalp blood testing for lactate became well-known in the 1990s. One study has shown that there is a correlation between both umbilical cord pH and lactate measurement in fetus arterial blood. From a physiological standpoint, lactate levels in tissues earlier increase before pH decreases in
207:
Using scalp lactate measurements compared to pH helps provide an easier and more affordable method than continuous electronic fetal monitoring. Nevertheless, literature has shown that both methods has no significant difference in measuring oxygen deprivation as well as in fetal outcome after
52:
Fetal blood sampling is a useful procedure that can diagnose, treat, or monitor different fetal problems. With the help of a small needle, various providers and specialists can remove small amounts of blood from the fetus. This procedure is used to help determine blood type, diagnose genetic
73:
One safer alternative to fetal scalp blood testing is what is called fetal scalp stimulation. It is a diagnostic test that helps detect metabolic acidemia. Fetal scalp stimulation is a second-line test that helps provide specialists reassurance that the labor process can safely continue. In
86:
Fetal scalp blood testing is associated with a relatively high failure rate of up to 20% due to variables such as sample contamination with air or amniotic fluid, or inadequate sample volume. Moreover, this process may be invasive, time-consuming, and painful for mother during labour. Rare
125:
Uterine contractions during labor and delivery decrease placental blood flow, therefore the fetus is at an increased risk of hypoxia. This is considered as one of the causes of acute fetal hypoxia among the likes of umbilical cord compression and myometrial contractures.
200:
shown that the mean umbilical arterial pH at birth predicts a pH > 7.25. An abnormal decreases in pH, on the other hand, is shown that there may be a potential risk of acidosis in fetus if the pH is below a threshold of 7.21.
1336:"Digital fetal scalp stimulation (dFSS) versus fetal blood sampling (FBS) to assess fetal wellbeing in labour-a multi-centre randomised controlled trial: Fetal Intrapartum Randomised Scalp Stimulation Trial (FIRSST NCT05306756)"
129:
Changes in fetal blood acidity can result in a shift in blood flow away from critical organs, particularly the brain. Conditions which have been reported in newborns who suffered fetal acidemia include
1238:
Baschat AA, Galan HL, Lee W, DeVore GR, Mari G, Hobbins J, et al. (April 2022). "The role of the fetal biophysical profile in the management of fetal growth restriction".
437:
1403:
70:
precision from the physician performing the procedure. Now, fetal scalp blood testing requires a considerable less amount of blood depending if testing pH or lactate.
94:
The procedure is contraindicated in the case of pregnancies less than 34 weeks, abnormal fetal heart rate, abnormal fetal blood status, and maternal infection.
903:
Fetal Scalp
Lactate Testing During Intrapartum Pregnancy with Abnormal Fetal Heart Rate: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines
1564:
1282:
1791:
1396:
1144:"Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress: randomised controlled multicentre trial"
61:
diseases before birth. Potential risks include bleeding from the fetal blood sampling site, infection, changes to heart rate, and death.
387:"Determination of Foetal Scalp Blood Sampling pH as an Indicator of Loss of Foetal Well-Being in Women Undergoing Caesarean Section"
1582:
957:"Foetal scalp blood sampling and ST-analysis of the foetal ECG for intrapartum foetal monitoring: a restricted systematic review"
385:
AlarcĂłn-RodrĂguez R, MartĂn-Ălvarez MP, GarcĂa-GonzĂĄlez J, Requena-Mullor M, RodrĂguez-GarcĂa MC, Zheng R, Rey RR (March 2023).
1849:
1693:
1389:
715:
1193:"Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace"
1191:
East CE, Leader LR, Sheehan P, Henshall NE, Colditz PB, Lau R (May 2015). Cochrane
Pregnancy and Childbirth Group (ed.).
1559:
226:
135:
561:
142:
1003:
Abdul Halim SF, Zakaria Z, Pusppanathan J, Mohd Noor A, Norali AN, Fazalul
Rahiman MH, et al. (February 2022).
851:
Murphy DJ, Devane D, Molloy E, Shahabuddin Y, et al. (Cochrane
Pregnancy and Childbirth Group) (January 2023).
665:
Murphy DJ, Devane D, Molloy E, Shahabuddin Y, et al. (Cochrane
Pregnancy and Childbirth Group) (January 2023).
44:
to confirm whether a fetus is receiving enough oxygen. This is a supplementary procedure used to determine if fetal
1688:
334:"Risk factors of incomplete Apgar score and umbilical cord blood gas analysis: a retrospective observational study"
1801:
1645:
1529:
1501:
1464:
1574:
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fetal scalp. After blood collection, pH and/or lactate levels are tested requiring up to 25 minutes per sample.
1569:
1741:
1491:
1381:
1436:
308:
111:
332:
van
Tetering AA, van de Ven J, Fransen AF, Dieleman JP, van Runnard Heimel PJ, Oei SG (November 2017).
1062:
1511:
1016:
619:
1811:
1708:
1587:
1506:
1334:
Murphy DJ, Shahabuddin Y, Yambasu S, O'Donoghue K, Devane D, Cotter A, et al. (October 2022).
906:. CADTH Rapid Response Reports. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health.
57:. Cardiocotography is the primary means of monitorning a fetus during pregnancy as well as labour.
514:"Accuracy of intrapartum fetal blood gas analysis by scalp sampling: A retrospective cohort study"
1764:
1746:
1736:
1263:
1142:
Wiberg-Itzel E, Lipponer C, Norman M, Herbst A, Prebensen D, Hansson A, et al. (June 2008).
364:
257:
Bohiltea RE, Mihai BM, Ducu I, Cioca AM, Bohiltea AT, Iordache AM, et al. (November 2022).
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Cummins G, Kremer J, Bernassau A, Brown A, Bridle HL, Schulze H, et al. (August 2018).
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131:
54:
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East, C. E.; Leader, L. R.; Sheehan, P.; Henshall, N. E.; Colditz, P. B.; Lau, R. (2015).
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1005:"A Review on Magnetic Induction Spectroscopy Potential for Fetal Acidosis Examination"
461:
Urdal J, Engan K, EftestĂžl T, Haaland SH, Kamala B, Mdoe P, et al. (March 2021).
1843:
1703:
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275:
107:
88:
1352:
1283:"Use of fetal scalp blood lactate for assessing fetal well-being during labour"
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901:
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403:
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41:
37:
1549:
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1177:
1121:
1048:
982:
911:
886:
837:
812:"Foetal scalp blood sampling during labour for pH and lactate measurements"
749:
716:"Stimulating the baby's scalp as a test of the baby's well-being in labour"
700:
651:
547:
498:
422:
360:
294:
115:
45:
512:
Hilal Z, Mrkvicka J, Rezniczek GA, Dogan A, Tempfer CB (December 2017).
1635:
1088:"The fetal brain sparing response to hypoxia: physiological mechanisms"
1029:
853:"Fetal scalp stimulation for assessing fetal well-being during labour"
667:"Fetal scalp stimulation for assessing fetal well-being during labour"
632:
1103:
816:
Best
Practice & Research. Clinical Obstetrics & Gynaecology
259:"Current Innovative Methods of Fetal pH Monitoring-A Brief Review"
1385:
714:
Murphy, D. J.; Devane, D.; Molloy, E.; Shahabuddin, Y. (2023).
102:
Two components that are commonly tested using this method are
309:"Fetal scalp pH testing Information | Mount Sinai - New York"
608:"Sensors for Fetal Hypoxia and Metabolic Acidosis: A Review"
114:. A low pH and high level of lactate indicate that there is
103:
770:"Nail abnormalities: MedlinePlus Medical Encyclopedia"
341:
The
Journal of Maternal-Fetal & Neonatal Medicine
141:
Scalp pH and lactate testing appear to have similar
1810:
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18:
810:Carbonne B, Pons K, Maisonneuve E (January 2016).
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562:"default - Stanford Medicine Children's Health"
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1240:American Journal of Obstetrics and Gynecology
8:
955:Demaegd H, Bauters E, Page GH (March 2020).
463:"Fetal heart rate development during labour"
1287:The Cochrane Database of Systematic Reviews
1197:The Cochrane Database of Systematic Reviews
857:The Cochrane Database of Systematic Reviews
720:The Cochrane Database of Systematic Reviews
671:The Cochrane Database of Systematic Reviews
1676:
1667:
1565:Percutaneous umbilical cord blood sampling
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7:
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932:. U.S. National Library of Medicine
118:, which in turn is associated with
961:Facts, Views & Vision in ObGyn
818:. Intrapartum Fetal Surveillance.
14:
1412:Tests and procedures relating to
930:MedlinePlus Medical Encyclopedia
1694:Artificial rupture of membranes
132:hypoxic-ischemic encephalopathy
1296:10.1002/14651858.CD006174.pub3
1206:10.1002/14651858.CD006174.pub3
869:10.1002/14651858.CD013808.pub2
732:10.1002/14651858.CD013808.pub2
683:10.1002/14651858.CD013808.pub2
1:
829:10.1016/j.bpobgyn.2015.05.006
467:BioMedical Engineering OnLine
353:10.1080/14767058.2016.1256985
1583:Lecithinâsphingomyelin ratio
1560:Fetal scalp stimulation test
1063:"Fetal scalp blood sampling"
227:Fetal scalp stimulation test
136:periventricular leukomalacia
1160:10.1136/bmj.39553.406991.25
530:10.1097/MD.0000000000008839
276:10.3390/diagnostics12112675
110:, both being indicators of
98:Fetal Monitoring Parameters
1866:
1353:10.1186/s13063-022-06794-9
1252:10.1016/j.ajog.2022.01.020
1086:Giussani DA (March 2016).
480:10.1186/s12938-021-00861-z
404:10.3390/healthcare11050725
1802:Resuscitative hysterotomy
1689:Assisted vaginal delivery
1646:External cephalic version
1555:Fetal scalp blood testing
1530:Chorionic villus sampling
1502:Vibroacoustic stimulation
1465:Obstetric ultrasonography
1092:The Journal of Physiology
566:www.stanfordchildrens.org
313:Mount Sinai Health System
34:Fetal scalp blood testing
19:Fetal scalp blood testing
926:"Fetal scalp pH testing"
900:Young C, Ryce A (2018).
27:assess fetal oxygenation
1765:Manual placenta removal
1492:Contraction stress test
1487:Fetal movement counting
442:www.hopkinsmedicine.org
36:is a technique used in
1850:Tests during pregnancy
1593:Fetal fibronectin test
438:"Fetal Blood Sampling"
55:cardiocotography (CTG)
1742:Wood's screw maneuver
112:acid base homeostasis
1757:Third stage of labor
1575:KleihauerâBetke test
1512:Amniotic fluid index
1067:acutecaretesting.org
182:4.2â4.8 mmol/L
1812:Postpartum bleeding
1792:On maternal request
1729:Dystocia management
1709:Obstetrical forceps
1588:Lamellar body count
1507:Biophysical profile
1437:Leopold's maneuvers
1154:(7656): 1284â1287.
1021:2022Senso..22.1334A
624:2018Senso..18.2648C
151:
1747:Zavanelli maneuver
1737:McRoberts maneuver
193:â„ 4.9 mmol/L
171:†4.1 mmol/L
149:
1837:
1836:
1833:
1832:
1779:Caesarean section
1773:
1772:
1714:Vacuum extraction
1619:
1618:
1480:Crown-rump length
1030:10.3390/s22041334
633:10.3390/s18082648
347:(21): 2539â2544.
197:
196:
150:Reference ranges
31:
30:
1857:
1677:
1672:Vaginal delivery
1668:
1611:Cardiotocography
1455:
1442:Prenatal testing
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1098:(5): 1215â1230.
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1641:Podalic version
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1518:
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1379:
1333:
1332:
1328:
1319:
1317:
1289:(5): CD006174.
1280:
1279:
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1237:
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1232:
1199:(5): CD006174.
1190:
1189:
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863:(1): CD013808.
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787:
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774:medlineplus.gov
768:
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726:(1): CD013808.
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677:(1): CD013808.
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1401:
1394:
1386:
1378:
1377:
1326:
1273:
1246:(4): 475â486.
1230:
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988:
967:(4): 337â346.
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1475:Anomaly scan
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436:McMacken M.
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269:(11): 2675.
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212:Advancements
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1719:Odon device
1540:Triple test
1470:Nuchal scan
1451:Fetal tests
1015:(4): 1334.
618:(8): 2648.
263:Diagnostics
143:sensitivity
1699:Episiotomy
1418:childbirth
1346:(1): 848.
1320:2023-08-04
1072:2023-08-01
936:2010-01-17
779:2023-08-01
755:2023-07-30
571:2023-07-31
447:2023-07-28
397:(5): 725.
391:Healthcare
318:2023-08-01
233:References
208:delivery.
89:hemophilia
38:obstetrics
1681:Induction
1550:Fetoscopy
1545:Quad test
1414:pregnancy
1268:247911334
822:: 62â67.
473:(1): 26.
187:Acidemia
179:7.21â7.24
78:Procedure
1844:Category
1787:Elective
1663:Delivery
1570:Apt test
1523:Sampling
1372:36195894
1315:25929461
1306:10823414
1260:35369904
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983:32322830
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887:36625680
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652:30104478
548:29245247
518:Medicine
499:33726745
423:36900730
414:10001157
361:27884069
295:36359522
221:See also
160:Lactate
116:acidosis
46:acidemia
1636:Fetendo
1458:Imaging
1363:9531493
1169:2413392
1113:4721497
1040:8963069
1017:Bibcode
1009:Sensors
974:7162663
878:9831024
741:9831024
692:9831024
643:6111374
620:Bibcode
612:Sensors
539:5728862
490:7962212
286:9689968
165:Normal
120:hypoxia
108:lactate
65:History
24:Purpose
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190:†7.20
168:â„ 7.25
1604:Other
1264:S2CID
365:S2CID
337:(PDF)
42:labor
1416:and
1368:PMID
1311:PMID
1256:PMID
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