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MATERNITY GUIDELINES
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Contents
1. Introduction ........................................................................................................................... 1
2. Indications for initial FBS analysis .................................................................................... 1
3. Contra-indications for FBS ................................................................................................. 2
4. Caution with FBS ................................................................................................................. 2
5. Taking the sample ............................................................................................................... 2
6. Interpretation of results ....................................................................................................... 3
7. When a fetal blood sample cannot be obtained ............................................................. 4
8. Second stage FBS .............................................................................................................. 4
9. Documentation and record keeping ................................................................................. 4
1. Introduction
Fetal blood sampling is a method of ascertaining further information surrounding intrapartum fetal wellbeing by assessing the fetal acid-base balance. This is achieved by obtaining a fetal scalp blood sample (FBS) via an amnioscope. This can be performed during the first or second stage of labour.
2. Indications for initial FBS analysis
A pathological fetal heart rate trace, where conservative measures have failed or immediate reassurance about fetal wellbeing is required.
Take into account the woman's preferences and the whole clinical picture.
Before carrying out fetal blood sampling, start conservative measures and offer digital fetal scalp stimulation. Only continue with fetal blood sampling if the cardiotocograph trace
Fetal blood sampling
remains pathological: If digital fetal scalp stimulation (during vaginal examination) leads to an acceleration in fetal heart rate, regard this as a sign that the baby is healthy. Take this into account when reviewing the whole clinical picture.
3. Contra-indications for FBS
Do not carry out fetal blood sampling if:
There is an acute event (for example, cord prolapse, suspected placental abruption or suspected uterine rupture) or
The whole clinical picture indicates that the birth should be expedited or
Contraindications are present, including risk of maternal-to-fetal transmission of infection (Hep B/C, HIV, and primary herpes) or risk of fetal bleeding disorders (haemophilia). However, if the HIV viral load is undetectable (less than 50), then the woman can have normal care in labour, including FBS if needed.
During or immediately after a prolonged deceleration.
4. Caution with FBS
Prematurity - between 34 and 36+6 weeks The following may give a falsely reassuring result on the FBS. Signs of intrapartum infection/ chorioamnionitis, maternal pyrexia > 38^0 C. Significant meconium stained liquor.
5. Taking the sample
Explain the following to the woman and her birth companion(s):
Why the test is being considered and other options available, including the risks, benefits and limitations of each.
The blood sample will be used to measure the level of acid in the baby's blood, which may help to show how well the baby is coping with labour.
The procedure will require her to have a vaginal examination using a device similar to a speculum.
A sample of blood will be taken from the baby's head by making a small scratch on the baby's scalp. This will heal quickly after birth, but there is a small risk of infection.
What the different outcomes of the test may be (normal, borderline and abnormal) and the actions that will follow each result.
If a fetal blood sample cannot be obtained but there are fetal heart rate accelerations in response to the procedure, this is encouraging and in these circumstances expediting the birth may not be necessary.
7. When a fetal blood sample cannot be obtained
If the associated fetal scalp stimulation results in fetal heart rate acceleration, decide whether to continue the labour or expedite the birth in light of the clinical circumstances.
If there has been no improvement in the cardiotocograph trace, expedite the birth.
8. Second stage FBS
Where a difficult assisted birth is contemplated in the presence of a pathological CTG, FBS should be undertaken. If the result is abnormal Cat 1 LSCS might be the most appropriate course of action.
9. Documentation and record keeping
It is expected that every episode of care be recorded clearly, in chronological order and as contemporaneously as possible by all healthcare professionals as per Hospital Trust Policy.
Documentation and record keeping MUST include:
Rationale for undertaking FBS together with documented management plan in notes dependent upon the outcome. All FBS results must be recorded in the patient records; additionally the machine print out must be secured within the labour record taking care not to obscure any written documentation. Blood samples must be labelled in the room prior to being taken to the blood gas analyser
All entries must have the date and time together with signature and printed name.
Training requirements
Audit of training needs compliance – please refer to TNA policy
Training needs analysis: Please refer to ‘Training Needs Analysis’ guideline together with training attendance database for all staff
Cross references
Maternity Hand Held Notes, Hospital Records and Record Keeping:
http://staffnet.plymouth.nhs.uk/Portals/1/Documents/Clinical%20Guidelines/Maternity/Ma
ternity%20hand%20held%20notes%20and%20hospital%20records.pdf?timestamp=
The monitoring of fetal well-being during labour: http://staffnet.plymouth.nhs.uk/Portals/1/Documents/Clinical%20Guidelines/Maternity/The% 0monitoring%20of%20fetal%20well- being%20during%20labour.pdf?timestamp=
Guideline development within the maternity services:
http://staffnet.plymouth.nhs.uk/Portals/1/Documents/Clinical%20Guidelines/Maternity/Guideli
ne%20development.pdf?timestamp=
References
National Institute for Clinical Excellence (2017) Clinical Guideline 190. Intrapartum Care for healthy women and babies. NICE, London.
Author Guideline Committee
Work Address Maternity Unit, Derriford Hospital, Plymouth, Devon, PL6 8DH
Version 6
Changes
Introduction of Taking the sample and discussion advise with the woman and her partner
Table 1 change of “intermediate” to “borderline”.
Advise on when a FBS sample cannot be obtained.
Date Ratified October 2018 Valid Until Date October 2023
