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Chapter 20

Fetal Blood Sampling (scalp pH)

Linda Rogers


To confirm/exclude fetal hypoxia in the presence of an abnormal CTG.


Trauma to the fetus
Vertical transmission of HIV (therefore only proceed if mother is known to be HIV negative)
Accepted normal values

pH > 7.25 normal; repeat every 30 minutes if the abnormal CTG pattern continues
pH 7.2 7.25 repeat as indicated (usually every 30 minutes)
pH 7.1 7.19 fetal acidosis expedite delivery
pH < 7.1 severe fetal acidosis deliver immediately


Mother to be at least 4cm dilated
Conical Speculum/Amnioscope and KY jelly
Ethyl chloride
Cotton wool / 4 x 3cm swabs
Petroleum jelly
Heparinised capillary tube
Blood gas machine
Large gauge needle/stylette

This can be done with the mother in lithotomy, or in the left lateral position with the legs
drawn up. Insert the speculum/amnioscope into the vagina, so that the narrow end rests on the
fetal scalp (away from any fontanelles). Clean any blood/mucous off the fetal scalp, and spray
with ethyl chloride. Dab with petroleum jelly (prevents the fetal blood from flowing away), and
make a small nick in the fetal scalp with the needle/stylette. Collect the resulting blood in the
heparinised capillary tube, insert into the blood gas machine in order to obtain the pH.
Interpret results as above.


Figure 1

Figure 2


Figure 3

Figure 4