Fetal Scalp Stimulation Versus Fetal Blood Sampling in Labour (FIRSST)
Intrapartum Fetal Distress
About this trial
This is an interventional diagnostic trial for Intrapartum Fetal Distress focused on measuring randomised controlled trial, fetal blood sampling, fetal scalp stimulation, cardiotocography, caesarean section
Eligibility Criteria
Inclusion Criteria:
- Nulliparous women
- Singleton pregnancy
- Cephalic presentation
- Gestational age 37+0 weeks or greater
- Abnormal CTG that requires second-line testing (FBS or dFSS)
Exclusion Criteria:
- Contraindication to FBS
- Limited understanding of English
- At the discretion of the responsible obstetrician in cases where there is urgency
Sites / Locations
- Coombe Women & Infants University HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Fetal Blood Sampling (FBS)
digital Fetal Scalp Stimulation (dFSS)
Fetal capillary blood samples will be collected in heparinised tubes and analysed in the delivery suite using the locally available gas analyser. The result of the first technically reliable sample, or the lowest reliable sample if multiple samples are tested, will be interpreted and acted upon according to the protocol, taking account of the clinical circumstances and the stage of labour: pH ≥7.25 normal, continue and if indicated repeat in 60 minutes; pH 7.21-7.24 borderline, repeat in 30 minutes; pH ≤ 7.20 abnormal, deliver.
The examiner will stimulate the fetal scalp digitally with the index and middle finger over a period of 30-60 seconds.The CTG will be observed over a 5-10 minutes interval after the dFSS and if a fetal heart rate acceleration (>15 bpm for 15 seconds) is observed the test will be considered normal. If there is an episode of normal variability (5-25 bpm) but there is no clear acceleration, the test will be considered borderline. If there is no FHR acceleration and no episode of normal variability with ongoing abnormal features, the test should be interpreted as abnormal in the same way as an abnormal FBS result. FHR acceleration normal, if indicated repeat in 60 min; Uncertain acceleration/ normal variability borderline, repeat in 30 minutes; No Acceleration/ongoing abnormal features abnormal, deliver.