Fetal blood sampling and cord gases

1. FETAL BLOOD SAMPLING
AND CORD GASES
BUSHRA SAEED
CHINONYE ANYANWU
UMAR HUSSAIN
HINCHINGBROOKE HOSPITAL, HUNTINGDON, CAMBRIDGESHIRE, UNITED
KINGDOM

2. BACKGROUND
• Used in conjunction with continuous fetal heart rate monitoring, fetal
blood sampling enables practitioners to interpret the level of fetal
compromise and ascertain the safest way forward
• The local guideline gives clear pathways for interpreting and
documenting these results and the actions that should follow
• Adhering to this means that CNST Level 3 Standard is achieved

3. REFERENCES
• National Institute for Health and Clinical Excellence. (CG 190, 2014).
Intrapartum care of healthy women and babies.
• National Health Service Litigation Authority. (2009). NHS Litigation Authority
Study Of Stillbirth Claims. London: NHSLA. Available at: www.nhsla.com
• Royal College of Anaesthetists, Royal College of Midwives, Royal College of
Obstetricians and Gynaecologists, Royal College of Paediatrics and Child
Health. (2007). Safer Childbirth: Minimum Standards for the Organisation
and Delivery of Care in Labour. London: RCOG Press. Available at:
www.rcog.org.uk

4. SPECIFIC OBJECTIVES
• To ensure that:
• The documentation of FBS results in the health record is correct
• Requirement and timing of repeated FBS with appropriate documentation
follows guideline
• Correct documentation of paired samples in the health record

5. AUDIT CRITERIA
Criterion Std expected
All FBS results documented in intrapartum notes 75%
All FBS results documented in black ink? 75%
For paired results, cord gases documented on p. 20 of intrapartum notes? 75%
Paired results documented in black ink? 75%
Paper print outs for FBS secured to intrapartum notes? 75%
Paper print outs for cord gases secured to intrapartum notes? 75%
Appropriate reason for FBS given? 75%
If repeated, within guideline timeframe? 75%
If third FBS performed, Consultant informed? 75%

6. METHODOLOGY
• 20 cases during the year January 2015 to January 2016 were used for
each arm of audit
• 2 part Audit: FBS and Paired cord sample without FBS
• Identified via maternity database as having had FBS or paired
samples
• Modified audit tool to measure against

7. METHODOLOGY DETAILS TO ALLOW EXACT
REPLICATION OF PROJECT
1: SAMPLE
• 20 cases audited
• Method of selection: cases highlighted by delivery database as having
had an FBS or paired cord samples
• Retrospective audit

8. METHODOLOGY DETAILS
PROFORMA
Q1 Hospital Number Yes No N/A
Q2 All FBS results documented in intrapartum notes?
Q3 All FBS results documented in black ink?
Q4 For paired results, cord gases documented on p. 20 of intrapartum notes?
Q5 Paired results documented in black ink?
Q6
Paper print outs for FBS secured to intrapartum notes?
Q7
Paper print outs for cord gases secured to intrapartum notes?
Q8
Appropriate reason for FBS given?
Q9 Repetition of FBS required as per guideline?
Q10
Repetition of FBS performed?
Q11 If repeated, within guideline timeframe?
Q12
If third FBS performed, Consultant informed?

9. RESULTS: FBS AUDIT (20 FBS PERFORMED )
Question % Achieved
1 Reason for FBS 100
2 Contraindications: 1 case only Sepsis N/A
3 Reason for not performing FBS documented 100
4 If acute compromise, FBS performed within 30 mins from bradycardia
(0 cases)
N/A
5 If acute compromise, FBS performed after 30 mins of recovery from
bradycardia (0 cases)
N/A
6 FBS documented: 100
7 Repeat FBS , results put in context (6 repeats) 100
8 If CTG pathological, repeat FBS no later than 1 hr (1 cases) 100

10. RESULTS: FBS AUDIT (20 FBS
PERFORMED)
Question % Achieved
9 FBS borderline, repeat FBS within 30 mins: 0
cases ( 1 case ,opted for EMCS)
N/A
10 If CTG unchanged, third FBS deferred ( 0 cases) N/A
11 3rd FBS, consultant opinion prior: 2 case opted
for EMCS
100
12 Failed FBS: Consultant informed : 1 case 100
13 Abnormal 3rd FBS, consultant informed: 0 cases N/A
14 Paired cord sample after birth: 20 cases 100

11. RESULTS: PAIRED CORD SAMPLE
WITHOUT FBS , 20 CASES
Question % Achieved
1 Reason for sample 100
2 If result abnormal, Paeds informed (19
cases, 1case normal results)
100
3 If paeds informed, plan of action by Paeds
(All 19 cases)
100
4 Result of paired sample documented: All 19
cases all criteria
100

12. CONCLUSIONS
Criterion Standard
Achieved 2016 (%)
(Standard achieved
2013)
All FBS results documented in intrapartum notes 100 (100)
All FBS results documented in black ink? 100 (100)
For paired results, cord gases documented on p. 20 of intrapartum notes? 100 (84)
Paired results documented in black ink? 95 (84)
Paper print outs for FBS secured to intrapartum notes? 100 (95)
Paper print outs for cord gases secured to intrapartum notes? 100 (87)
Appropriate reason for FBS given? 100 (100)
If repeated, within guideline timeframe? 100 (100)
If third FBS performed, Consultant informed? 100 (100)

13. ACTION PLAN
• Inform clinicians/ midwives at their induction that cord
gases must be documented in and print outs securely
fixed within intrapartum notes
• Continue to highlight at LSCS and Senior Midwife
meetings,
• induction of medical staff,
• User guide on gas machine

14. DISCUSSIONS / POINTS FROM
PRESENTATION / MEETINGS
• CNST standards achieved
• Close the audit loop
• Recommendations to continue current practice