Landmark clinical trial for midwifery, obstetrics and neonatology with potential for positive global impact
A new research project at Trinity College Dublin could have far-reaching implications for the management of labour; making monitoring less intrusive and potentially reducing the number of unnecessary caesarean sections in Ireland. The study, which focuses on tests of fetal wellbeing in labour, sets out to make childbirth safer while reducing unnecessary interventions, and is being led by Professor Deirdre Murphy, Chair of Obstetrics in the School of Medicine in Trinity. The project has recently received almost 1 Million Euro funding from the Health Research Board of Ireland.
Hypoxia in labour (which occurs when a baby receives inadequate oxygen to its brain before, during, or after delivery) can lead to irreversible brain injury and death. In order to monitor this, doctors use cardiotocography (CTG) in high-risk pregnancies to monitor the fetal heart rate, allowing early intervention if necessary. CTG abnormalities are relatively common and can lead to the decision to deliver by emergency caesarean section. However, in as many as 60% of cases the fetus is subsequently found to have been compensating for the stress of labour and was not actually compromised.
Fetal blood sampling (FBS) is a more invasive secondary test that requires a blood sample to be taken from the scalp of the fetus. This provides information on the acid-base status of the fetus, reflecting hypoxia. It is used to provide either reassurance that labour can continue, or more objective evidence that delivery needs to be expedited. Clinical guidelines in the UK and Ireland treat FBS as a gold standard test. However, recent studies have questioned the validity and reliability of FBS, and also the logistical challenges of achieving a result in a timely manner.
Fetal scalp stimulation (FSS) is an alternative test of fetal wellbeing in labour in which the examiner stimulates the fetal scalp with the index finger over a period of 30 to 60 seconds. It is less invasive, gives results quicker (which can be vital in emergency scenarios) and can be incorporated into a standard vaginal examination performed by a midwife or obstetrician. It has been highlighted as an alternative to FBS in new Irish Guidelines but there is a lack of evidence to support one test over another.
Prof. Murphy’s research aims to compare the FSS and FBS tests in a multi-centre randomised controlled trial to see how they compare in terms of primarily caesarean section, but also operative vaginal delivery, low Apgar scores, cord blood acidosis, and admission to the special care baby unit.
If the findings of the study show that FSS is as good as or superior to FBS, then this programme of work holds the prospect of changing and improving the way labour is managed across maternity services worldwide.
Prof. Murphy said:
“I and my colleagues are grateful to the Health Research Board for approving the funding to enable our team to investigate this area. Almost 70,000 babies are born each year in Ireland. Adverse birth-related events include cerebral palsy, perinataI death, maternal morbidity and mortality. These outcomes impose a huge physical, emotional and financial burden on affected families, the health service and society in general. The overall objective of this project is to make childbirth safer while reducing unnecessary intervention in labour. This is a landmark clinical trial for midwifery, obstetrics and neonatology that has the potential to have a positive impact globally.”
About Dr. Deirdre Murphy
Dr. Murphy is Chair in Obstetrics in the School of Medicine, Trinity College Dublin and Head of Obstetrics in the Coombe Women & Infants University Hospital. Dr. Murphy’s research interests incorporate applied and aetiological epidemiology, clinical trials, and laboratory-based studies exploring the pathogenesis of pregnancy related disorders. The overall research theme of her group is “Care of Women and babies during pregnancy and childbirth.” Dr. Murphy collaborates with colleagues in Obstetrics, Midwifery, Neonatology, Anaesthetics, Clinical Medicine, Epidemiology and Public Health, Primary care, Health Informatics, Health Services Research and Basic Sciences. She has an International reputation in the field of operative delivery and adverse perinatal outcomes. She set up a unique operative delivery cohort in the UK and has worked on a range of National and Regional perinatal databases including the ALSPAC cohort in Bristol, the Walker cohort in Dundee and more recently a cohort of over 60,000 births at the Coombe Women & Infants University Hospital in Dublin. Her group has focused more recently on randomised controlled trials and has completed four multi-centre trials. They have been actively involved in National and International guideline development which has facilitated implementation of their research findings into evidence-based practice guidelines.
About School of Medicine, Trinity College Dublin
The School of Medicine is one of the world’s top medical schools (QS world rankings 51-100, 2019 for Medicine). It is the leading research School in Trinity contributing approximately a fifth of all Trinity research income. For more information see here: https://www.tcd.ie/medicine/about/
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