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Labour and Delivery Posters
Complications of intrapartum fetal monitoring: a case of neonatal scalp abscess following fetal blood sample (FBS) and fetal scalp electrode (FSE)
  1. A Hardiman,
  2. J Charova,
  3. A Muotune
  1. Royal Bolton Hospital, Bolton, United Kingdom

Abstract

Background A 2006 Cochrane review demonstrated that although the use of CTG reduces the incidence of neonatal seizures, it makes no difference on the incidence of cerebral palsy or neonatal mortality. Fetal scalp electrodes are commonly used to accurately monitor fetal heart rate during labour in cases of poor CTG contact. Fetal blood sampling has also been used for over 60 years as a means of providing a more direct assessment of fetal well-being.

Case We present the case of a neonate, born to a 21 year old primigravida by emergency caesarean section. During labour, a fetal blood sample was taken and a fetal scalp electrode applied for accurate monitoring. Five days following discharge, the baby presented with seizures and a scalp abscess around the site of the FBS/FSE. Following CT scan, the baby was transferred to a tertiary unit for surgical drainage. Simultaneously, his mother was re-admitted with intra-abdominal sepsis with pelvic abscess requiring laparotomy and washout twice. Mother and baby both made a full recovery.

Discussion We review the literature and investigate the incidence of reported complications secondary to the process of fetal blood sampling and fetal scalp electrode application over the past 40 years. We discover that complications are rare, with the most frequent appearing to be haemorrhage, followed by infection, alongside some more isolated adverse events. We also revisit contraindications and precautions to prevent complications and conclude that, although uncommon, the clinician should be reminded that these are invasive techniques and are not without their risks.

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