Background: Cardiotocography (CTG) is a screening test used to detect fetal hypoxia in labour. It has a high false positive rate resulting in many potentially unnecessary caesarean sections. Fetal blood sampling (FBS) is a second-line test of the acid-base status of the fetus. It is used to provide either reassurance that it is safe for labour to continue or objective evidence of compromise so that delivery can be expedited. Digital fetal scalp stimulation (dFSS) to elicit a fetal heart rate acceleration is an alternative less invasive second-line test of fetal wellbeing. This study aims to provide robust evidence on the role of these two second-line tests in assessing fetal wellbeing and potentially preventing operative delivery.
Methods: A multi-centre parallel group randomised controlled trial (RCT) is planned in four maternity centres in Ireland. The study aims to recruit 2500 nulliparous women with a term (≥37+0 weeks) singleton pregnancy who require a second-line test of fetal wellbeing in labour due to an abnormal CTG. Women will be allocated randomly to dFSS or FBS on a 1:1 ratio. The primary outcome is caesarean section. With 1250 women in each arm, the study will have 90% power to detect a difference of 5-6%, at a two-sided alpha significance level of 5%, assuming a caesarean section rate of at least 20% in the dFSS group.
Discussion: If the proposed study shows evidence that dFSS is a safe, reliable and effective alternative to FBS, this would have ground-breaking implications for labour management worldwide. It could potentially lead to a reduction in invasive procedures and emergency caesarean sections.
Trial Registration: ClinicalTrials.gov NCT05306756. Registered on 31 March 2022. The trial commenced enrolment on 10 May 2022. Ethical committee approval has been granted by the Research Ethics Committee (REC) of each hospital: Dublin/CWIUH REC: 12.06.2019; Cork/UCC REC: 29.11.2019; Galway/NUIG REC: 06.09.2019; Limerick/UL REC: 30.09.2019.
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http://dx.doi.org/10.1186/s13063-022-06794-9 | DOI Listing |
Int J Gynaecol Obstet
January 2025
Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
Pulmonary sequestration is a rare pulmonary malformation, typically characterized by asymptomatic presentation or recurrent pulmonary infections, with chest pain and hemothorax being exceedingly rare occurrences. The rupture and hemorrhage of maternal pulmonary sequestration during pregnancy pose a life-threatening condition that is challenging to diagnose. We present a case of a 37-year-old pregnant woman in her third trimester who presented with acute progressive hemothorax, a complication arising from maternal pulmonary sequestration.
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January 2025
Department of Psychiatry, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea.
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View Article and Find Full Text PDFBMC Public Health
January 2025
Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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View Article and Find Full Text PDFBJOG
January 2025
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Objective: To study the effects of chorioamnionitis on uterine activity and to investigate associations between external and intrauterine monitoring methods and neonatal outcomes.
Design: Secondary analysis of a randomised controlled trial cohort.
Setting: Two labour wards, in a university tertiary hospital and a central hospital.
Women Birth
January 2025
School of Nursing, Midwiferyand Social Work The University of Queensland, Brisbane, QLD 4072, Australia; Women's and Newborn Services, Royal Brisbane Women's Hospital, MetroNorth Health, Australia. Electronic address:
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