Fetal Pulse Oximetry markers of the fetal cardiac and medullary responses to blood volume would be difficult to demonstrate
responses to blood volume would be difficult to demonstrate since death is a rare outcome; even
xygen saturation monitoring does not only apply to infants and adults. In
some special cases, even the unborn may need constant monitoring.
The Procedure
Intrapartum oxygen saturation monitoring or fetal oxygen saturation
monitoring is an examination performed to assess the well-being of the
baby during the early course of labor. This is done by a doctor or a midwife
who will insert a catheter-like probe inside the vagina during labor. The
catheter should lodge on the face, particularly the cheek or the scalp of the
fetus to get a good reading. It may take a few minutes and cause minor
discomfort during the insertion. And in most cases, fetal pulse oximetry is
done along with an internal fetal monitoring device.
The Device
Fetal pulse oximetry is a relatively new technique in the assessment of a
fetus prior to delivery. It has been useful in reducing the number of
caesarean sections because of the immediate availability of its results.
The probe transmits specific wavelengths of light to determine the amount
of oxygen beneath the baby’s skin. It functions like a fetal scalp electrode
that is hooked to an external monitor that reads the data gather from the
reflected lights. It measures both the pulse rate and oxyhemoglobin
saturation and puts in on display. The data may also be recorded for future
reference. Most importantly, the probe should be lodged securely to the
skin to get an accurate reading. The physician will provide an objective
reading of the results in line with the fetal heart tracing. Should there be
any abnormalities in the baby’s oxygenation, he may decide to proceed
with a cesarean delivery.
The procedure, however, because of its recent development, studies are
yet to be conducted in terms of the reliability of its results. So far, the
parameters for false positive and false negative readings are still not
available.
http://www.pulseoximeterhelp.com/tag/intrapartum-oxygen-saturation-
monitoring/
Intrapartum fetal heart rate assessment
INTRODUCTION
Assessment of the fetus during labor is a challenging task. The rationale
for monitoring the fetal heart rate (FHR) is that FHR patterns are indirect
changes, acidemia, and hypoxemia, since the brain modulates heart rate.
Virtually all obstetrical organizations advise monitoring the FHR during
labor. This position is largely based upon the experience of experts and
medicolegal precedent; no trials comparing electronic fetal monitoring
versus no monitoring have been performed [1]. A trial comparing
auscultation with no monitoring found that auscultation was associated
with an increased risk of operative delivery without any reduction in
perinatal mortality [2]. Furthermore, no reliable auscultatory indicator of
fetal distress has been determined, other than extreme changes in FHR
[3]. Thus, neither electronic fetal monitoring nor auscultation have been
proven to reduce mortality, despite large clinical trials [4].
Intrapartum fetal monitoring will be discussed here. Fetal cardiac
physiology, FHR patterns, and antepartum FHR monitoring (nonstress test,
contraction stress test) are reviewed separately. (See"Antepartum fetal
heart rate assessment".)
EFFECTIVENESS OF INTRAPARTUM FHR MONITORING
The primary goal of FHR monitoring is to identify hypoxemic and acidotic
fetuses in whom timely intervention will prevent death. A secondary goal is
to avoid fetal neurologic injury, if possible. The two commonly used
modalities for intrapartum FHR monitoring, continuous electronic FHR
monitoring and intermittent auscultation, have been extensively reviewed;
there is no high quality evidence that these techniques achieve either of
these goals or that one performs better than the other in low risk
pregnancies [4-10]. Analysis of data from randomized trials comparing
these two techniques shows [6]:
• The intrapartum fetal death rate is approximately 0.5 per 1000
births with either approach
• Apgar scores and neonatal intensive care unit admission rates
are similar for both modalities
• Neither approach reduces the risk of long-term neurologic
impairment or cerebral palsy.
Use of electronic FHR monitoring instead of intermittent auscultation has
not led to a reduction in the overall risk of perinatal death (RR 0.85, 95%
CI 0.59-1.23) [6]. However, significant decrease in the perinatal death rate
pooling results from multiple trials lacked sufficient power to provide a
definitive conclusion.
Intrapartum fetal scalp lactate sampling for fetal assessment in the
presence of a non-reassuring fetal heart rate trace.
East CE, Leader LR, Sheehan P, Henshall NE, Colditz PB.
Department of Obstetrics and Gynaecology, University of Melbourne,
Pregnancy Research Centre, Department of Perinatal Medicine, Royal
Women's Hospital, 20 Flemington Road, Parkville, Victoria, Australia,
3052.
Abstract
BACKGROUND: Fetal blood sampling for lactate estimation may be
considered following identification of an abnormal or non-reassuring fetal
heart rate pattern. The smaller volume of blood required for this test,
compared with the more traditional pH estimation, may improve sampling
rates. The appropriate use of this practice mandates systematic review of
its safety and clinical effectiveness prior to widespread introduction.
OBJECTIVES: To evaluate the effectiveness and risks of fetal scalp
lactate sampling in the assessment of fetal well-being during labour,
compared with no testing or alternative testing.
SEARCH STRATEGY: We searched the Cochrane Pregnancy and
Childbirth Group's Trials Register (November 2009).
SELECTION CRITERIA: All published and unpublished randomised and
quasi-randomised trials that compared fetal scalp lactate testing with no
testing or alternative testing to evaluate fetal status in the presence of a
non-reassuring cardiotocograph during labour.
DATA COLLECTION AND ANALYSIS: Two review authors assessed the
studies independently.
MAIN RESULTS: The two identified randomised trials considered
outcomes for 3348 mother-baby pairs allocated to either lactate or pH
estimation of fetal blood samples in labour. There were no statistically
significant differences for any fetal/neonatal/infant outcomes, including low
Apgar score at five minutes, admission to neonatal intensive care units or
neonatal encephalopathy, or for low umbilical arterial pH, base deficit or
metabolic acidaemia. There was a statistically higher success rate for
lactate compared with pH estimation (risk ratio 1.10, 95% confidence
interval 1.08 to 1.12, n = 2992). There were no significant between-group
differences in mode of birth or operative birth for non-reassuring fetal
status. No studies reported outcomes of maternal satisfaction with fetal
monitoring, anxiety, length of hospital stay or economic analysis.
AUTHORS' CONCLUSIONS: When further testing to assess fetal well-
being in labour is indicated, fetal scalp blood lactate estimation is more
likely to be successfully undertaken than pH estimation. Action cut-off
lactate values need to consider the lactate meter used. Further studies
may consider sub-group analysis by gestational age, the stage of labour
and sampling within a prolonged second stage of labour. Additionally,
future studies may address longer-term neonatal outcomes, maternal
satisfaction with intrapartum fetal monitoring and an economic analysis.

http://www.ncbi.nlm.nih.gov/pubmed/20238343