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Is intrapartum vibratory acoustic stimulation a valid alternative to fetal scalp pH determination?
O Irion1, P Stuckelberger, J M Moutquin
1Hôpital Saint-François d' Assise, Département de Gynécologie et d' Obstétrique, Université Laval, Quèbec, Canada.
Objectives:
To determine the association between fetal heart rate accelerations, whether spontaneous or induced by vibratory acoustic stimulation, and subsequent scalp pH values in presence of a suspicious intrapartum fetal heart rate tracing, and thereby assess the ability of accelerations to predict a concurrent normal fetal scalp blood pH.
Design:
Prospective observational study of 253 labours involving 421 pH samples.
Setting:
Tertiary care university hospital of Genoeva.
Intervention:
Vibratory acoustic stimulation through the maternal abdominal wall for five seconds prior to fetal blood sampling.
Main Outcome Measures:
Spontaneous fetal heart rate reactivity (accelerations) in the 10 min preceding vibratory acoustic stimulation, vibratory acoustic-induced reactivity prior to fetal blood sampling, and scalp pH value.
Results:
The positive predictive value of a reactive fetal heart rate response after vibratory acoustic stimulation was 78% (95% CI 73-84%) and 97% (95% CI 94-99%) for scalp pH values of > 7.25 and > or = 7.20, respectively. Similar observations occurred with spontaneous reactivity. Of concern, 7 out of 31 (23%) occasions where the scalp blood pH was less than 7.20 appeared to be associated with a normal fetal heart rate response to vibratory acoustic stimulation.
Conclusion:
Fetal heart rate acceleration induced by vibratory acoustic stimulation was significantly associated with a normal scalp blood pH higher than 7.25. However, vibratory acoustic stimulation offers no advantage over observation of spontaneous fetal heart rate tracings and cannot safely replace fetal blood sampling during labour.