Neonatal complications associated with use of fetal scalp electrode: a retrospective study

Abstract

Objectives

To estimate the incidence and risk of complications associated with fetal scalp electrode and to determine whether its application in the setting of operative vaginal delivery was associated with increased neonatal morbidity.

Design

Retrospective cohort study.

Setting

Twelve clinical centers with 19 hospitals across nine American Congress of Obstetricians and Gynecologists US districts.

Population

Women in the United States.

Methods

We evaluated 171,698 women with singleton deliveries ≥ 23 weeks gestation in a secondary analysis of the Consortium on Safe Labor study between 2002 and 2008, after excluding conditions that precluded fetal scalp electrode application such as prelabor cesarean delivery. Secondary analysis limited to operative vaginal deliveries ≥ 34 weeks of gestation also was performed.

Main outcome measures

Incidences and adjusted odds ratios (aOR) with 95% confidence intervals (CI) of neonatal complications were calculated, controlling for maternal characteristics, delivery mode and pregnancy complications.

Results

Fetal scalp electrode was used in 37,492 (22%) of deliveries. In non-operative vaginal delivery, fetal scalp electrode was associated with increased risk of injury to scalp due to birth trauma (1.2% vs 0.9%; aOR=1.62; 95%CI=1.41–1.86) and cephalohematoma (1.0% vs 0.9%; aOR=1.57; 95%CI=1.36–1.83). Neonatal complications were not significantly different comparing fetal scalp electrode with vacuum assisted vaginal delivery and vacuum assisted vaginal delivery alone or comparing fetal scalp electrode with forceps assisted vaginal delivery and forceps assisted vaginal delivery alone.

Conclusions

We found increased neonatal morbidity with fetal scalp electrode though the absolute risk is very low. It is possible that these findings reflect an underlying indication for its use. Our findings support the use of fetal scalp electrode when clinically indicated.