Evaluating the value of intrapartum fetal scalp blood sampling to predict adverse neonatal outcomes: A UK multicentre observational study.
Bassel H Al Wattar, Aarti Lakhiani, Adalina Sacco, Aditi Siddharth, Alexandra Bain, Alexandra Calvia, Atiyah Kamran, Bing Tiong, Bethan Warwick, Caroline MacMahon, Diana Marcus, Emma Long, Gillian Coyle, Gillian Elizabeth Lever, Gina Michel, Gomathy Gopal, Hana Baig, Hannah Louise Price, Hawra Badri, Helen Stevenson, Helene Hoyte, Humaira Malik, Jade Edwards, Jennifer Hartley, Jennifer Hemers, Jennifer Tamblyn, John Alexander William Dalton, Jonathan Frost, Kamana Subba, Kathryn Baxter, Kavitha Sivakumar, Kelly Murphy, Konstantinos Papadakis, Laura Rachel Bladon, Lorraine Kasaven, Louisa Manning, Mathew Prior, Mausumi Ghosh, Melanie Couch, Melis Altunel, Melissa Pearce, Michael Cocker, Michael Stephanou, Michelle Jie, Minesh Mistry, Mohammed Osama Wahby, Nabila Shahid Saidi, Nicola Louise Ramshaw, Nicola Tempest, Nina Parker, Phoebe L Tan, Racheal Louise Johnson, Rachel Harris, Rachel Tildesley, Ramya Ram, Ritu Painuly, Romana Cuffolo, Roberta Bugeja, Rose Ngadze, Rosie Grainger, Sabitra Gurung, Sammy Mak, Sara Farrell, Sarah Cowey, Sarah Neary, Sarah Quinn, Simrit Kaur Nijjar, Sophie Kenyon, Stephanie Lamb, Susan Tracey, Tara Lee, Therese Kinsella, Trecia Davidson, Trent Corr, Uzo Sampson, Victoria McQueen, William Parry Smith, Zora Castling, AB-FAB study group
Author Information
Bassel H Al Wattar: Warwick Medical School, The University of Warwick, Coventry CV4 7AJ, UK. Electronic address: dr.basselwa@gmail.com.
Aarti Lakhiani: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Adalina Sacco: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Aditi Siddharth: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Alexandra Bain: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Alexandra Calvia: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Atiyah Kamran: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Bing Tiong: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Bethan Warwick: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Caroline MacMahon: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Diana Marcus: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Emma Long: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Gillian Coyle: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Gillian Elizabeth Lever: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Gina Michel: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Gomathy Gopal: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Hana Baig: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Hannah Louise Price: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Hawra Badri: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Helen Stevenson: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Helene Hoyte: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Humaira Malik: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Jade Edwards: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Jennifer Hartley: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Jennifer Hemers: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Jennifer Tamblyn: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
John Alexander William Dalton: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Jonathan Frost: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Kamana Subba: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Kathryn Baxter: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Kavitha Sivakumar: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Kelly Murphy: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Konstantinos Papadakis: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Laura Rachel Bladon: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Lorraine Kasaven: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Louisa Manning: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Mathew Prior: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Mausumi Ghosh: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Melanie Couch: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Melis Altunel: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Melissa Pearce: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Michael Cocker: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Michael Stephanou: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Michelle Jie: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Minesh Mistry: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Mohammed Osama Wahby: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Nabila Shahid Saidi: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Nicola Louise Ramshaw: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Nicola Tempest: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Nina Parker: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Phoebe L Tan: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Racheal Louise Johnson: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Rachel Harris: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Rachel Tildesley: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Ramya Ram: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Ritu Painuly: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Romana Cuffolo: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Roberta Bugeja: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Rose Ngadze: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Rosie Grainger: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Sabitra Gurung: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Sammy Mak: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Sara Farrell: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Sarah Cowey: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Sarah Neary: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Sarah Quinn: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Simrit Kaur Nijjar: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Sophie Kenyon: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Stephanie Lamb: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Susan Tracey: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Tara Lee: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Therese Kinsella: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Trecia Davidson: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Trent Corr: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Uzo Sampson: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Victoria McQueen: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
William Parry Smith: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
Zora Castling: The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology.
OBJECTIVE: To evaluate the value of fetal scalp blood sampling (FBS) as an adjunct test to cardiotocography, to predict adverse neonatal outcomes. STUDY DESIGN: A multicentre service evaluation observational study in forty-four maternity units in the UK. We collected data retrospectively on pregnant women with singleton pregnancy who received FBS in labour using a standardised data collection tool. The primary outcome was prediction of neonatal acidaemia diagnosed as umbilical cord arterial pH < 7.05, the secondary outcomes were the prediction of Apgar scores<7 at 1st and 5th minutes and admission to the neonatal intensive care unit (NICU). We evaluated the correlation between the last FBS blood gas before birth and the umbilical cord blood and adjusted for time intervals. We constructed 2 × 2 tables to calculate the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) and generated receiver operating curves to report on the Area Under the Curve (AUC). RESULTS: In total, 1422 samples were included in the analysis; pH values showed no correlation (r = 0.001, p = 0.9) in samples obtained within an hour (n = 314), or within half an hour from birth (n = 115) (r=-0.003, p = 0.9). A suboptimal FBS pH value (<7.25) had a poor sensitivity (22%) and PPV (4.9%) to predict neonatal acidaemia with high specificity (87.3%) and NPV (97.4%). Similar performance was noted to predict Apgar scores <7 at 1st (sensitivity 14.5%, specificity 87.5%, PPV 23.4%, NPV 79.6%) and 5th minute (sensitivity 20.3%, specificity 87.4%, PPV 7.6%, NPV 95.6%), and admission to NICU (sensitivity 20.3%, specificity 87.5%, PPV 13.3%, NPV 92.1%). The AUC for FBS pH to predict neonatal acidaemia was 0.59 (95%CI 0.59-0.68, p = 0.3) with similar performance to predict Apgar scores<7 at 1st minute (AUC 0.55, 95%CI 0.51-0.59, p = 0.004), 5th minute (AUC 0.55, 95%CI 0.48-0.62, p = 0.13), and admission to NICU (AUC 0.58, 95%CI 0.52-0.64, p = 0.002). Forty-one neonates had acidaemia (2.8%, 41/1422) at birth. There was no significant correlation in pH values between the FBS and the umbilical cord blood in this subgroup adjusted for sampling time intervals (r = 0.03, p = 0.83). CONCLUSIONS: As an adjunct tool to cardiotocography, FBS offered limited value to predict neonatal acidaemia, low Apgar Scores and admission to NICU.
