Multicenter study on the clinical value of fetal pulse oximetry


      Objective: Our purpose was to compare the predictive value of intrapartum fetal pulse oximetry with that of fetal blood analysis for an abnormal neonatal outcome in case of an abnormal fetal heart rate. Study design: A prospective multicenter observational study was conducted from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded with a Nellcor N-400 fetal pulse oximeter in case of an abnormal fetal heart rate during labor. Simultaneous readings of fetal oxygen saturation and fetal blood analysis obtained before birth (i.e., either at full dilatation or before cesarean section when indicated) were compared with the neonatal status. The criteria for an abnormal neonatal outcome were (1) an umbilical arterial blood pH ≤7.15 and (2) a combined variable including 5-minute Apgar score ≤7, umbilical arterial pH ≤7.15, secondary respiratory distress, transfer in a neonatal care unit, or neonatal death. Results: At a 7.20 threshold for fetal scalp pH and 30% for fetal oxygen saturation (i.e., the 10th percentile in the study population), the predictive value of fetal pulse oximetry was similar to that of fetal blood analysis for an arterial umbilical pH ≤7.15 and for an abnormal neonatal outcome (positive predictive value 56% vs 55%, negative predictive value 81% vs 82%, sensitivity 29% vs 35%, and specificity 93% vs 91%, respectively). The receiver-operator characteristic curve showed similar performance of either technique for cutoff values ≤7.20 for fetal blood pH and ≤30% for fetal oxygen saturation, whereas fetal pulse oximetry became superior at higher thresholds. Conclusion: The predictive value of intrapartum fetal pulse oximetry can be favorably compared with that of fetal blood analysis. Randomized controlled management trials can now be performed to assess potential clinical benefits of this new tool. (Am J Obstet Gynecol 1997;177:512-8.)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Peat S
        • Booker M
        • Lanigan C
        • Ponte J.
        Continuous intrapartum measurement of fetal oxygen saturation [letter].
        Lancet. 1988; 2: 213
        • Gardosi JO
        • Schram CM
        • Symonds EM.
        Adaptation of pulse oximetry for fetal monitoring during labour.
        Lancet. 1991; 1: 1265-1267
        • Johnson N
        • Johnson VA
        • Fisher J
        • Jobbings B
        • Bannister J
        • Lilford RJ.
        Fetal monitoring with pulse oximetry.
        Br J Obstet Gynaecol. 1991; 98: 36-41
        • Dildy CA
        • Clark SL
        • Loucks CA.
        Preliminary experience with intrapartum fetal pulse oximetry in humans.
        Obstet Gynecol. 1993; 81: 630-635
        • Gardosi JO
        • Damianou D
        • Schram C.
        Artifacts in fetal pulse oximetry: incomplete sensor-to-skin contact.
        Am J Obstet Gynecol. 1994; 170: 1169-1173
        • Jongsma HW
        • Crevels J
        • Menssen JJM
        • Arts THM
        • Mulders JGM
        • Nijhuis JG
        • et al.
        Application of transmission and reflection pulse oximetry in fetal lambs.
        in: Fetal and neonatal physiological measurements. Elsevier, Amsterdam1991: 123-128
        • Luttkus AK
        • Dudenhausen JW.
        Fetal pulse oximetry.
        in: Intrapartum surveillance. Baillieres Clin Obstet Gynaecol. 10. 1996: 295-306
        • East CE
        • Colditz PB
        • Dunster KR
        • Khoo SK.
        Human fetal intrapartum oxygen saturation monitoring: agreement between readings from two sensors on the same fetus.
        Am J Obstet Gynecol. 1996; 174: 1594-1598
        • MacNamara H
        • Chung DC
        • Lilford R
        • Johnson N.
        Do fetal pulse oximetry readings correlate with cord blood oxygenation and acidaemia?.
        Br J Obstet Gynaecol. 1992; 99: 735-738
        • Carbonne B
        • Audibert F
        • Segard L
        • Sebban E
        • Cabrol D
        • Papiernik E.
        Fetal pulse oximetry: correlation between changes in oxygen saturation and neonatal outcome.
        Eur J Obstet Gynecol Reprod Biol. 1994; 57: 73-77
        • Langer B
        • Boudier E
        • Haddad J
        • Pain L
        • Schlaeder G.
        Fetal pulse oximetry during labour of 62 patients.
        Fetal Diagn Ther. 1996; 11: 37-45
        • Dildy GA
        • van den Berg P
        • Katz M
        • Clark SL
        • Jongsma HW
        • Nijhuis JG
        • et al.
        Intrapartum fetal pulse oximetry: fetal oxygen saturation trends during labor and relation to delivery outcome.
        Am J Obstet Gynecol. 1994; 171: 179-184
        • Seelbach-Gobel B
        • Butterwegge M
        • Kuhnert M
        • Heupel M.
        Fetal reflectance pulse oximetry sub partu: experiences, prognostic significance, and consequences and goals.
        Z Geburtshilfe Perinatol. 1994; 198: 67-71
        • Prentice A
        • Lind T.
        Fetal heart rate monitoring during labour; too frequent intervention, too little benefit?.
        Lancet. 1987; 2: 1375-1377
        • MacDonald D
        • Grant A
        • Sheridan-Pereira M
        • Boylan P
        • Chalmers I.
        The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring.
        Am J Obstet Gynecol. 1985; 152: 524-539
        • Saling E.
        Fetal scalp blood analysis.
        J Perinat Med. 1981; 9: 165-177
        • Clark SL
        • Paul RH.
        Intrapartum fetal surveillance: the role of fetal scalp blood sampling.
        Am J Obstet Gynecol. 1985; 153: 717-720
        • van den Berg P
        • Schmidt S
        • Gesche J
        • Saling E.
        Fetal distress and the condition of the newborn using cardiotocography and fetal blood analysis during labour.
        Br J Obstet Gynaecol. 1987; 94: 72-75