Second line tests of fetal wellbeing in labor – A national survey of practice in the Republic of Ireland

Objective

The aim of this study was to evaluate obstetricians’ views on digital fetal scalp stimulation (dFSS) and fetal blood sampling (FBS), and to establish their reported practice when performing second line tests of fetal wellbeing in labor.

Methods

A survey was distributed via email and post to every trainee and consultant obstetrician in maternity units in the Republic of Ireland. The survey explored current practice, views on test performance, and the management of clinical scenarios with abnormal intrapartum cardiotocography.

Results

We received 177 responses from 430 doctors (41 %). There was a perception that dFSS is easier (93 %) and faster to perform (94 %), but that FBS is the most reliable test (59 % FBS, 5 % dFSS, 22 % no difference). The need for a well-designed randomized controlled trial to determine which test performs best was recognized (80 %). Willingness to participate in such a trial was higher among trainees than consultants (91 % versus 67 %, p = 0.001). There was marked variation in reported practice for the clinical scenarios and diverse views were expressed within the free-text comments.

Conclusion

Perspectives on dFSS and FBS vary between clinicians. This uncertainty about commonly used intrapartum tests supports the need for randomized controlled trials to provide robust evidence on the effectiveness of each test.