Breakthrough trial could reduce number of unnecessary C-sections

22 Nov 2019

Image: © falonkoontz/

An Irish research team has received backing for a significant clinical trial that could reduce the number of unnecessary C-sections.

A project led by Prof Deirdre Murphy, chair of obstetrics in the School of Medicine at Trinity College Dublin (TCD), is a recent recipient of €1m from the Health Research Board. Its objective is to examine tests of foetal wellbeing in labour, potentially reducing the need for unnecessary interventions such as Caesarean sections (C-sections).

One of the most common reasons for a C-section is a fear of hypoxia in labour. This occurs when a baby receives inadequate oxygen to its brain before, during, or after delivery and may result in severe brain damage or even death.

To monitor this, doctors use cardiotocography (CTG) in high-risk pregnancies to monitor the foetal heart rate, however, in as many as 60pc of cases, the delivered foetus is found to have been compensating for the stress of labour and was not actually compromised.

A more invasive test involves foetal blood sampling (FBS), which requires a blood sample being taken from the scalp of the foetus. While clinical guidelines consider it the gold standard of hypoxia tests – by measuring the acid-base status of the foetus – recent studies have brought its use into question.

Making childbirth safer

An alternative is foetal scalp stimulation (FSS), in which the examiner stimulates the foetal scalp with the index finger over a period of between 30 and 60 seconds. While less invasive and producing results quicker than FBS, there is little evidence to support its use over an established test.

Murphy and her team will now look to compare FBS and FSS in a multi-centre randomised controlled trial to see how they compare in terms of C-sections, but also operative vaginal delivery, low Apgar scores, cord-blood acidosis and admission to the special care baby unit.

If this shows FSS to be superior to FBS, it could change how labour is managed across maternity services worldwide.

“Almost 70,000 babies are born each year in Ireland. Adverse birth-related events include cerebral palsy, perinatal death, maternal morbidity and mortality,” Murphy said.

“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.”

Colm Gorey was a senior journalist with Silicon Republic