Skip to main content
SpringerLink
Log in

Correlation of fetal scalp blood sampling pH with neonatal outcome umbilical artery pH value

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Fetal scalp blood sampling is considered as a complimentary tool in addition to cardiotocography to assess fetal well-being. This blood sampling is important as the obstetrician has to judge and make decisions regarding the further management of the delivery based on this pH result. The aim of this study was to analyze the correlation between fetal scalp blood pH and the umbilical artery pH after birth. Furthermore, it was investigated whether tocolysis, a performed episiotomy or cord encirclement have an influence on the umbilical artery pH.

Methods

This retrospective study over a period of 11 years included all singleton pregnancies without fetal anomalies, which were monitored by fetal scalp blood sampling during labor.

Results

844 out of 1502 deliveries were included for analysis. The analysis demonstrates a good correlation between fetal scalp pH value and outcome pH value. Subgroup analysis with fetal scalp blood pH <7.20 showed a difference in 40 of 82 cases, with an outcome pH value ≥7.20, but this difference was statistically insignificant. Neither did tocolysis, episiotomy or the presence of cord encirclement show an overall effect, nor did they have an impact on the subgroup.

Conclusion

Obstetricians must consider that the values of fetal scalp blood are not always reliable and can be false. However, on the basis of CTG and fetal scalp blood pH, decisions are made regarding delivery interventions. Therefore, we would encourage the consideration of taking two samples routinely at every attempt of fetal blood sampling.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Jorgensen JS, Weber T (2014) Fetal scalp blood sampling in labor: a review. Acta Obstet Gynecol Scand 93:548–555

    Article  PubMed  Google Scholar 

  2. East CE, Leader LR, Sheehan P, Henshall NE, Colditz PB, Lau R (2015) Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace. Cochrane Database Syst Rev 1:5

    Google Scholar 

  3. Wiberg-Itzel E, Lipponer C, Norman M, Herbst A, Prebensen D, Hansson A et al (2008) Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress: randomised controlled multicentre trial. BMJ 336:1284–1287

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Westerhuis ME, van Horen E, Kwee A, van der Tweel I, Visser GH, Moons KG (2009) Inter- and intra-observer agreement of intrapartum ST analysis of the fetal electrocardiogram in women monitored by STAN. BJOG 116:545–551

    Article  CAS  PubMed  Google Scholar 

  5. Devane D, Lalor J (2005) Midwives’ visual interpretation of intrapartum cardiotocographs: intra- and inter-observer agreement. J Adv Nurs 52:133–141

    Article  PubMed  Google Scholar 

  6. Epstein AJ, Twogood S, Lee RH, Opper N, Beavis A, Miller DA (2013) Interobserver reliability of fetal heart rate pattern interpretation using NICHD definitions. Am J Perinatol 30:463–468

    PubMed  Google Scholar 

  7. Ayres-de-Campos D, Bernardes J, Costa-Pereira A, Pereira-Leite L (1999) Inconsistencies in classification by experts of cardiotocograms and subsequent clinical decision. Br J Obstet Gynaecol 106:1307–1310

    Article  CAS  PubMed  Google Scholar 

  8. Rhöse S, Heinis AMF, Vandenbussche F, van Drongelen J, van Dillen J (2014) Inter- and intra-observer agreement of nonreassuring cardiotocography analysis and subsequent clinical management. Acta Obstet Gynecol Scand 93:596–602

    Article  PubMed  Google Scholar 

  9. Haverkamp AD, Orleans M, Langendoerfer S, McFee J, Murphy J, Thompson HE (1979) A controlled trial of the differential effect of intrapartum fetal monitoring. Am J Obstet Gynecol 134:399–409

    CAS  PubMed  Google Scholar 

  10. Alfirevic Z, Devane D, Gyte GM (2013) Continuous CTG as a form of electronic fetal monitoring for fetal assessment during labour. Cochrane Database Syst Rev CD006066. doi:10.1002/14651858.CD006066.pub2

  11. Weber T (1982) CTG supplemented with continuous fetal pH monitoring during labour. Acta Obstet Gynecol Scand 61:351–355

    CAS  PubMed  Google Scholar 

  12. East CE, Leader LR, Sheehan P, Henshall NE, Colditz PB (2010) Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace. Cochrane Database Syst Rev 3:CD006174

    PubMed  Google Scholar 

  13. Sherman DJ, Arieli S, Raziel A, Bukovsky I (1994) The effect of sampling technique on measurement of fetal blood pH and gases: an in vitro system. Am J Obstet Gynecol 171:1125–1128

    Article  CAS  PubMed  Google Scholar 

  14. Morgan BLG, Chao CR, Iyer V, Ross MG (2002) Correlation between fetal scalp blood samples and intravascular blood pH, pO2 and oxygen saturation measurements. J Matern Fetal Neonatal Med 11:325–328

    Article  CAS  PubMed  Google Scholar 

  15. Parer JT (1980) The current role of intrapartum fetal blood sampling. Clin Obstet Gynecol 23:565–582

    Article  CAS  PubMed  Google Scholar 

  16. Mahendru AA, Lees CC (2011) Is intrapartum fetal blood sampling a gold standard diagnostic tool for fetal distress? Eur J Obstet Gynecol Reprod Biol 156:137–139

    Article  PubMed  Google Scholar 

  17. O’Brian YM, Murphy DJ (2013) The reliability of fetal blood sampling as a test of fetal acidosis in labour. Eur J Obstet Gynecol Reprod Biol 167:142–145

    Article  Google Scholar 

  18. Liljestrom L, Wikstrom AK, Hanson U, Akerud H, Jonsson M (2011) Evaluation of the discrepancy between pH and lactate in combined fetal scalp blood sampling. Acta Obstet Gynecol Scand 90:1088–1093

    Article  PubMed  Google Scholar 

  19. Chandraharan E, Wiberg N (2014) Fetal scalp blood sampling during labor: an appraisal of the physiological basis and scientific evidence. Acta Obstet Gynecol Scand 93:544–547

    Article  PubMed  Google Scholar 

  20. Funk A, Heyl W, Rother R, Winkler M, Rath W (1995) Subpartale Diagnose von Nabelschnurumschlingungen mittels farbcodierter Dopplersonographie und Korrelation zu kardiotokographischen Veränderungen während des Geburtsverlaufes. Geburtsh u Frauenheilk 55:623–627

    Article  CAS  Google Scholar 

  21. Bogdan C, Meyer C, Rϋttgers H, Kubli F (1971) Die Azidosegefährdung des Fetus bei Nabelschnurumschlingung. Schweiz Z Gynäk Geburtsh 2:441–444

    Google Scholar 

  22. Bruce S, James SL, Bowe E, Rey H, Shamsi H (1978) Umbilical cord complications as a cause of perinatal morbidity and mortality. J Perinat Med 6:89–94

    Article  CAS  PubMed  Google Scholar 

  23. Spellacy WN, Gravem H, Fisch RO (1966) The umbilical cord complications of true knots, nuchal coils, and cords around the body. Report from the collaborative study of cerebral palsy. Am J Obset Gynecol 94:1136–1142

    Article  CAS  Google Scholar 

  24. Larson LD, Rayburn WF, Crosby S, Thurnau GR (1995) Multiple nuchal cord entanglements and intrapartum complications. Am J Obstet Gynecol 173:1228–1231

    Article  CAS  PubMed  Google Scholar 

  25. Jauniaux E, Ramsay B, Peellaerts C, Scholler Y (1995) Perinatal features of pregnancies complicated by nuchal cord. Am J Perinatol 12:255–258

    Article  CAS  PubMed  Google Scholar 

  26. Ertan AK, Schmidt W (1994) Nabelschnurumschlingung und farbcodierte Doppler-Sonographie. Geburtsh u Frauenheilk 54:196–203

    Article  CAS  Google Scholar 

  27. Sornes T (1995) Umbilical cord encirclements and fetal growth restriction. Obstet Gynecol 86:725–728

    Article  CAS  PubMed  Google Scholar 

  28. Osak R, Webster KM, Bocking AD, Campbell MK, Richardson BS (1997) Nuchal cord evident at birth impacts on fetal size relative to that of the placenta. Early Hum Dev 49:193–202

    Article  CAS  PubMed  Google Scholar 

  29. Clapp JF 3rd, Stepanchak W, Hashimoto K, Ehrenberg H, Lopez B (2003) The natural history of antenatal nuchal cords. Am J Obstet Gyencol 189:488–493

    Article  Google Scholar 

  30. Schäffer L, Burkhardt T, Zimmermann R, Kurmanavicius J (2005) Nuchal cords in term and postterm deliveries- do we need to know? Obstet Gyencol 106:23–28

    Article  Google Scholar 

  31. Martin GC, Green RS, Holzman IR (2005) Acidosis in newborns with nuchal cords and normal APGAR scores. J Perinatol 25:162–165

    Article  PubMed  Google Scholar 

  32. Önderogly LS, Dursun P, Durukan T (2008) Perinatal features and umbilical cord blood gases in newborns complicated with nuchal cord. Turk J Pediatr 50:466–470

    Google Scholar 

  33. Sadan O, Fleischfarb Z, Everon S, Golan A, Lurie S (2007) Cord around the neck: should it be severed at delivery? A randomized controlled study. Am J Perinatol 24:61–64

    Article  PubMed  Google Scholar 

  34. Yeomans ER, Hauth JC, Gilstrap EC, Strickland DM (1985) Umbilical cord pH, pCO2 and bicarbonate following uncomplicated term vaginal deliveries. Am J Obstet Gynecol 151:798–800

    Article  CAS  PubMed  Google Scholar 

  35. Carey JC, Rayburn WF (2003) Nuchal cord encirclements and birth weight. J Reprod Med 48:460–462

    PubMed  Google Scholar 

  36. Yeh P, Emary K, Impey L (2012) The relationship between umbilical cord arterial pH and serious adverse neonatal outcome: analysis of 51519 consecutive validated samples. BJOG 119:824–831

    Article  CAS  PubMed  Google Scholar 

  37. Chandraharan E (2014) Fetal scalp blodd sampling during labour: is it a useful diagnostic test or a historical test that no longer has a place in modern clinical obstetrics? BJOG 121:1056–1062

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Medical School of Hanover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    E. Kuehnle, S. Herms, F. Kohls, S. Kundu, P. Hillemanns & Ismini Staboulidou

Authors
  1. E. Kuehnle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Herms
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Kohls
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Kundu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Hillemanns
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ismini Staboulidou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ismini Staboulidou.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kuehnle, E., Herms, S., Kohls, F. et al. Correlation of fetal scalp blood sampling pH with neonatal outcome umbilical artery pH value. Arch Gynecol Obstet 294, 763–770 (2016). https://doi.org/10.1007/s00404-016-4053-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-016-4053-6

Keywords

Search

Navigation