Quality statement 7: The use of fetal blood sampling

Quality statement

Women in labour for whom a caesarean section is being considered for suspected fetal compromise are offered fetal blood sampling to inform decision-making.

Rationale

Fetal blood sampling is recommended if delivery by caesarean section is contemplated because of an abnormal fetal heart rate pattern or in cases of suspected fetal acidosis. Fetal blood sampling helps the maternity team to make a more informed judgement about whether to recommend a caesarean section or to continue with a vaginal delivery.

Quality measure

Structure:
a) Evidence of local arrangements to ensure that women in labour for whom a caesarean section is being considered for suspected fetal compromise are offered fetal blood sampling to inform decision-making.

b) Evidence of local arrangements to ensure that maternity units have access to a functioning and serviced fetal blood gas analyser.

Process:
a) The proportion of women in labour for whom a caesarean section is being considered for suspected fetal compromise who are offered fetal blood sampling to inform the decision.

Numerator – The number of women in the denominator who are offered fetal blood sampling.

Denominator – The number of women in labour for whom a caesarean section is being considered for suspected fetal compromise without contraindications for fetal blood sampling.

b) The proportion of women in labour in whom a fetal blood sample was attempted and a fetal blood reading was made.

Numerator – the number of women in the denominator in whom the fetal blood sample was successfully obtained and a reading made.

Denominator – the number of pregnant women in whom a fetal blood sample was attempted.

Outcome: Unplanned caesarean section rates.

What the quality statement means for each audience

Service providers ensure that systems are in place for women in labour for whom a caesarean section is being considered for suspected fetal compromise to be offered fetal blood sampling to inform decision-making.

Healthcare professionals ensure that women in labour for whom a caesarean section is being considered for suspected fetal compromise are offered fetal blood sampling to inform decision-making.

Commissioners ensure that they commission services that have systems in place for women in labour for whom a caesarean section is being considered for suspected fetal compromise to be offered fetal blood sampling to inform decision-making.

Women in labour for whom a caesarean section is being considered because of concerns about the baby are offered a blood test from the baby's scalp (called fetal blood sampling) to help decide whether a caesarean section is needed.

Source guidance

NICE clinical guideline 132 recommendation 1.3.2.5.

Data source

Structure: a) and b) Local data collection.

Process: a) and b) Local data collection.

Outcome: Local data collection.

Definitions

Suspected fetal compromise

Abnormal fetal heart rate pattern or suspected fetal acidosis.

Fetal blood sampling

Sampling should be undertaken when it is technically possible to do so and there are no contraindications. The National Sentinel Caesarean Section Audit defines 'technically possible' as cervical dilation of 4 cm or more. If there is clear evidence of acute fetal compromise (for example, prolonged deceleration greater than 3 minutes), fetal blood sampling should not be undertaken and urgent preparations to expedite birth should be made. If fetal blood sampling is not attempted because of contraindications, the contraindications should be documented in the woman's maternity notes.