title: Fetal monitoring in labor: are accelerations good enough?
abstract: OBJECTIVE
  To investigate whether accelerations of the fetal heart rate in response to scalp stimulation (the scalp stimulation test) before fetal scalp blood sampling (FBS) are such a good predictor of fetal well-being as to render the FBS unnecessary.
  
  
  METHODS
  A retrospective observational study. Cardiotocograms (CTG) from 54 fetuses during labor in whom 70 FBS procedures were performed, were analysed by an investigator blinded to the outcome, to determine whether accelerations were present in response to fetal scalp stimulation during vaginal examination (VE) prior to the FBS. This was compared with the pH obtained at FBS in a 2 x 2 table. The primary outcome measure was the false negative rate of the scalp stimulation test.
  
  
  RESULTS
  There were accelerations at 48 VEs before FBS (n = 70). In five cases there was fetal acidosis (pH<or=7.20). Three of these five fetuses had accelerations at VE, giving a false negative rate of 6.25%.
  
  
  CONCLUSIONS
  These data do not support previous reports that accelerations in response to fetal scalp stimulation before FBS exclude fetal acidosis when the CTG is suspicious and FBS is otherwise indicated. A larger sample may help answer this question.
authors.affiliation: Department of Obstetrics & Gynaecology, Southmead Hospital, Bristol, UK. rubencho@btinternet.com
authors.forename: Ruben D
authors.initials: RD
authors.lastname: Trochez
authors.forename: Thabani
authors.initials: T
authors.lastname: Sibanda
authors.forename: Rohit
authors.initials: R
authors.lastname: Sharma
authors.forename: Tim
authors.initials: T
authors.lastname: Draycott
mesh_terms: D000138:Acidosis / Q000097:blood / Q000175:diagnosis*; D001034:Apgar Score; D001800:Blood Specimen Collection; D015148:Cardiotocography; D005188:False Negative Reactions; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006340:Heart Rate, Fetal; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007743:Labor, Obstetric; D010812:Physical Stimulation; D011247:Pregnancy; D012189:Retrospective Studies; D012535:Scalp / Q000098:blood supply; D012680:Sensitivity and Specificity