Prediction in early labour of subsequent operative delivery for fetal distress

SummarySummaryThe usefulness of a fetal heart rate trace, an umbilical artery Doppler study and vibro-acoustic stimulation as screening admission tests in a low risk population for subsequent development of intrapartum fetal distress requiring operative delivery were compared. The study group consisted of 68 admissions to the labour ward in spontaneous labour. Neither the fetal heart record nor the umbilical artery Doppler alone was able to discriminate between normal and abnormal fetal outcomes. An abnormal vibro-acoustic response (10 per cent of women studied) had a positive predictive value of 57 per cent for ‘operative delivery for fetal distress'. Predictive values of the fetal heart record and Doppler were low (8 to 12 per cent) but both had reasonable specificities and negative predictive value (87 to 97 per cent) in predicting adverse fetal outcome. The detection rate of the fetal heart record and vibro-acoustic stimulation together for ‘operative delivery for fetal distress' was five times greater than the fetal heart record alone. The fetal heart rate response to vibro-acoustic stimulation on admission appears to be a more reliable predictor of fetal well-being in early labour than the fetal heart record alone. This information could be used to allocate patients to either low or high risk groups and allow increased fetal surveillance with early detection of acidosis.