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Launceston General Hospital Clinical Guideline P2010/0494-001 2.

21/09WACS Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Fetal Scalp Blood Sampling Fetal Scalp Blood Sampling WACSClinProc2.21/06
Fetal blood sampling to assess fetal compromise in the presence of a non reassuring CTG during labour with ROM

Midwifery and Medical Staff, Queen Victoria Maternity Unit Fetal distress, acidosis, pH, lactate P2010/0486-001 Intrapartum Fetal Monitoring

Purpose: To check fetal acidosis levels in the presence of non reassuring fetal monitoring. Background: Increased intervention rates associated with electronic fetal monitoring can be reduced with the use of fetal blood sampling (FBS). The use of scalp lactate results in less failed procedures, is easier to perform and requires smaller sample volume. Delivery should be expedited where: Significant fetal acidosis is suspected There is clear evidence of serious fetal compromise (FBS should not be undertaken) CTG abnormalities are of a degree requiring further assessment, but FBS is contraindicated, clinically inappropriate or not feasible. Contraindications: Clear evidence on continuous EFM of serious, sustained fetal compromise. Fetal bleeding disorders Face presentation Maternal infection HIV, hepatitis, herpes simplex virus and suspected intrauterine sepsis Prematurity < 34 weeks Equipment: Fetal scalp blood sampling kit Light source Blood lactate monitor Lactate Pro Procedure: This procedure is performed by a registrar or consultant. Place the woman in lithotomy position with a wedge or left lateral position. A vaginal examination establishes vaginal dilation and fetal position. Amnioscope is inserted gently onto the fetal head. Clean the fetal scalp. If required parafin ointment is smeared over the scalp to ensure droplet formation. A small incision is made in the fetal scalp, in the upper portion of the visible scalp. With the sampling tube directed upward to the incision site, the sample is collected via capillary action.
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Ensure haemostasis prior to remove of Amnioscope. Check fetal heart rate. Document procedure and result in womans medical record.

Results The scalp pH or lactate result should be interpreted taking into account any previous measurement, the rate of progress in labour and other clinical circumstances. Lactate >5.7 4.9 4.1 < 3.2 pH <7.0 7.0 - 7.15 7.15 -7.25 > 7.3 Plan Deliver immediately Obstetric emergency Deliver within 30 minutes Repeat in 30 minutes No action if CTG reassuring If CTG non reassuring then repeat in 30 minutes

Lactate above 4.9 or pH below 7.15 is an obstetric emergency. Intrauterine resuscitation should commence while awaiting transfer to theatre. Documentation Fetal scalp lactate >4.9 or pH<7.20 must be reported on the Electronic Incident Management System (EIMS). Attachments
Attachment 1 Attachment 2 Users Guide for Lactate Scout References

Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit annually by clinical Quality improvement Midwife WACS Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years (February 2012). Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Stakeholders: Developed by:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Date: 06/05/09

Fetal Scalp Blood Sampling Oct-10

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APPENDIX 1 USER GUIDE FOR LACTATE PRO

Peel test strip foil packet to the line indicated and insert the test strip into the strip inlet. The function number and the last measured test result will blink alternately on the display. Make sure the function number matches the number on the display. Place capillary tube with blood at the tip of the strip. The result will be displaced in 60 seconds.

Calibration Strip Once the test meter has been setup with the calibration strip, additional calibrations are not required until a new box of test strips is used. The calibration strip should be kept until the box of test strips is emptied.

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APPENDIX 3 REFERENCES Royal Australian and New Zealand College of Obstetricians and Gynaecologists, 2006, Intrapartum Fetal Surveillance. Clinical Guidelines Second Edition Allen RM, Bowling FG, Oatts J. Determining the fetal scalp lactate level that indicates the need for intervention in labour. Australian and New Zealand Journal of Obstetrics and Gynaecology 2004; 44:549-52

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