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The appropriate use of fetal blood sampling (FBS) in reducing the caesarean section rate in waterford regional hospital
  1. I Offiah,
  2. I Giwa-Amu,
  3. J Bermingham,
  4. J Stratton,
  5. E O'Donnell
  1. Waterford Regional Hospital, Waterford, Ireland

Abstract

Cardiotocographic assessment (CTG) when used with fetal blood sampling (FBS) has been demonstrated to increase specificity in detecting fetal distress. FBS however is difficult and requires operator experience.

Our aims were to assess:

  1. The impact of FBS on CS rate.

  2. Inter observer variation in CTG interpretation.

  3. Overuse of FBS.

  4. FBS use at full dilatation.

We carried out retrospective analysis of 94 cases of deliveries in WRH from January–June 2009 having a successful FBS. Blinded case summaries and CTG strips were reviewed by three Obstetricians. They were asked whether the FBS was warranted, if in the absence of an FBS, would they continue with observation, and in situations where a vaginal delivery was unattainable, would they proceed to caesarean section.

Results (1) FBS reduced the CS rate by 4.23%. (2) 14.86% of cases all three observers felt that the FBS was unnecessary, while in 10.81% of cases the FBS was performed for reassurance purposes. (3) In the subgroup of women having had FBS at full dilatation, 72.7% of cases was warranted, 18.2% of FBS done at 10 cm was for reassurance. 36% FBS were done in preference to operative vaginal delivery, where the circumstances for vaginal delivery was appropriate.

The use of FBS with CTG reduced the section rate in WRH by 4.23%.

CTG interpretation in suspected fetal distress is subject to extensive inter-observer variation with a concordance rate of only 28.38%. FBS in our study is being overused, with 14.86% of cases deemed inappropriate.

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