Involving the consultant before fetal blood sampling

Area of Science:

• Obstetrics and Gynecology
• Fetal Monitoring
• Clinical Decision Making

Background:

• Fetal scalp lactate (FSL) testing is used with abnormal cardiotocography (CTG) to reduce unnecessary interventions.
• However, FSL has a low positive predictive value, leading to potential overtreatment.

Purpose of the Study:

• To evaluate the impact of consultant obstetrician review of abnormal CTGs before FSL testing.
• To assess the effect on intervention rates and perinatal outcomes.

Main Methods:

• A retrospective cohort study compared outcomes before and after implementing a policy requiring consultant review of abnormal CTGs prior to FSL.
• Data on mode of birth and fetal acidemia were analyzed.

Main Results:

• The new policy significantly reduced FSL rates (1.7% vs 3.5%) and the incidence of neonatal acidaemia (pH < 7.1).
• Rates of caesarean sections for fetal distress (CS for FD) and instrumental births also decreased.
• Adjusted analysis confirmed a reduced likelihood of CS for FD (aOR = 0.78).

Conclusions:

• Consultant review of abnormal CTGs before FSL enhances pretest probability and reduces unnecessary interventions.
• This policy is associated with lower rates of CS for FD, instrumental births, and FSL procedures.