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Fetal monitoring and labor accelerations – Reply
RUBEN D. TROCHEZ
Obstetrics & Gynaecology, Derriford Hospital, Plymouth, PL6 8DH, UK
We wish to thank Dr Ross for his interest in our study. We agree that the base excess could provide additional evidence of the degree of metabolic acidosis, but fetal acidosis is almost invariably a mixture of respiratory and metabolic acidosis Citation[1],Citation[2], and therefore this can sometimes lead to confusion.
In the UK, where this study was undertaken, fetal blood sampling (FBS) is recommended by the National Institute for Clinical Excellence (NICE) Citation[3] for all units performing electronic fetal monitoring and the pH alone is used for decision-making.
This does not seem to be the case in the USA, but we do not think that this difference in practice should detract from the main findings of the study: that our data do not support previous reports that accelerations in response to fetal scalp stimulation before FBS exclude fetal acidosis when the CTG is suspicious. Our data help corroborate the NICE guideline recommendation that FBS should be employed where the CTG is non-reassuring and vaginal delivery is possible.
Ruben D. Trochez
Specialist Registrar in Obstetrics & Gynaecology
Derriford Hospital
Plymouth, PL6 8DH, UK
E-mail: [email protected]