Scalp abscess: A complication of the spiral fetal electrode CRAIG
A.
DONALD JOHN
WINKEL, L.
B.
Son Francisco,
M.D.
SN+DER,
SCHLAERTH,
M.D M.D.
California
During the period from September, 1974, to January, 1975, we perjormed 276 deliveries, of whirh 5-t per cent ulere internal4 monitored with a spiral type oj jetal electrode. Eight of the infants monitored (incidence, 5.4 per cent) developed scalp abscesws. We had had no preuious complications associated with the electrodes. 2d n intensive investigation was conducted to detect the causative factor(s) of the,fetal srujp inject&w. case histories of the mothers and infants were scrutinized, instruments were e.xamined, the erwironment and techniques ufere analyzed. ‘4 ,surz~e~~ of maternal and infant complications during the period from September, 1973, to August, 1974, senled as control. Thejindings indicated that a dtff erent type of coil electrode had been ,sabstituted for the brand use had used previowly. The nk coil electrode had a barb at the tip, presumably to @went its falling out of the scalp. We discontinued the use of the coil zehich had become suspect and returned to the type we had used jneuiouslv. We haw not had another incidence of fetal scalp infection assoriated with intra@artum monitoring.
(AM. J. OBSTET.GYNECOL.
126: 720, 1976.)
INTRAPARTUM fetal heart rate monitoring, a technique whereby an electrode is attached to the fetal scalp, is an accepted obstetric practice during the time the mother is in labor. Different types of electrodes have been devised. It was observed that the original clamp-on electrode could result in contusions and lacerations on the fetal scalp and, subsequently, a screwon spiral type was designed. There have been reports of superficial scalp abscesses resulting from the use of both of these types of electrodes (incidence, 0.3 to 0.4
From the Department of Obstetrics Letterman .4rmy Medical Center.
per cent).le3 One fetal death resulting from a severe infection beginning at the scalp electrode site has been reported.’ Since January, 1974, we have used the screw-on spiral type electrode for intrapartum fetal heart rate monitoring in 55 per cent of 394 patients in labor. We had no fetal scalp infections until September. 1974. During the next 5 months, we performed 276 deliveries, of which 54 per cent vyere internally monitored with a spiral type of fetal scalp electrode. Scalp abscesses developed in eight infants who had been monitored. Of these eight scalp infections, seven were severe but none was fatal. Four of the infections were caused by gram-negative rods; bacteroides species were isolated in two of the cases. Our incidence of infection associated with the fetal heart rate monitoring was 5.4 per cent during the epidemic period. In January, 1975, an intensive investigation was instituted to find the causative factors of the epidemic. The electrode used for fetal heart rate monitoring became suspect. We immediately discontinued the use of that model and purchased the model we had used before the epidemic. We have had no further incidences of infant scalp abscesses or complications associated with the electrode.
and Gynecology*
Presented at the Armed Forces Distract Meeting, American College of Obstetricians and Gynecologists, San .4ntonio, Texas, I?owmbu, 1975. The opinion.s and assertions contained herein are the private view of the authors and are not to be construed as ofjcial or as reflecting the views of the Department of the Army or the Department of Defense. Received
for publication
Revised June ‘4ccepted
June
January
12, 1976.
1, 1976. 18, 1976.
Reprin! reqnest.s: Technical Publications Editar. Letterman Army Medical Center, Presidio of San Franrisco. Cahfornia 94129.
720
Scalp abscess with spiral fetal electrode
Table
I. Maternal
721
data
Episiotomy exten.s&t (degree)
I
24
2
22
ll/ 0 6/3O
3
19
2140
Amniotomy Amniotomy
(11) (8)
Leaking on admission A4mniotomy Amniotomy
(14) (10) (8)
19% 7t
35 180
15 9
7
40
6
16+ 15
82 94
14 10
4 .5
24 22
1 O/ 0 71 0
6
28
41 0
Amniotomy
(4)
@
7
26
8/15
.4mniotomy
(8)
8%
180
5
8
21
Spontaneous home (30)
at
17+
87
10
ll/
0
*All mothers were primigravidas except Patient tAugmented by intravenous oxytocin (Pitocin). $One fetal scalp sample.
Table
II. Infant
lll~unt
No.
1, who
1 2
(days)
Gram
14
*I & D = incision and ?Tip of fetal electrode
stain
Negative Gram-negative Negative Gram-positive Gram-negative Negative Gram-positive Unknown
7 3 2 5 2 14 14
3 4 .5 6 7 8
drainage. was recovered
from
case
and materials histories
infant
complications
served
as control.
the
environment
of
of
the
same
The
instruments
and
techniques
period
was
were were
made
examined
and and
analyzed.
maternal
Fourth Fourth
Cesarean section ELF
None
Spontaneous
Fourth
2. All mothers
Fourth
were
Culture
para
XOll
A.
DONALD JOHN
WINKEL, L.
B.
Son Francisco,
M.D.
SN+DER,
SCHLAERTH,
M.D M.D.
California
During the period from September, 1974, to January, 1975, we perjormed 276 deliveries, of whirh 5-t per cent ulere internal4 monitored with a spiral type oj jetal electrode. Eight of the infants monitored (incidence, 5.4 per cent) developed scalp abscesws. We had had no preuious complications associated with the electrodes. 2d n intensive investigation was conducted to detect the causative factor(s) of the,fetal srujp inject&w. case histories of the mothers and infants were scrutinized, instruments were e.xamined, the erwironment and techniques ufere analyzed. ‘4 ,surz~e~~ of maternal and infant complications during the period from September, 1973, to August, 1974, senled as control. Thejindings indicated that a dtff erent type of coil electrode had been ,sabstituted for the brand use had used previowly. The nk coil electrode had a barb at the tip, presumably to @went its falling out of the scalp. We discontinued the use of the coil zehich had become suspect and returned to the type we had used jneuiouslv. We haw not had another incidence of fetal scalp infection assoriated with intra@artum monitoring.
(AM. J. OBSTET.GYNECOL.
126: 720, 1976.)
INTRAPARTUM fetal heart rate monitoring, a technique whereby an electrode is attached to the fetal scalp, is an accepted obstetric practice during the time the mother is in labor. Different types of electrodes have been devised. It was observed that the original clamp-on electrode could result in contusions and lacerations on the fetal scalp and, subsequently, a screwon spiral type was designed. There have been reports of superficial scalp abscesses resulting from the use of both of these types of electrodes (incidence, 0.3 to 0.4
From the Department of Obstetrics Letterman .4rmy Medical Center.
per cent).le3 One fetal death resulting from a severe infection beginning at the scalp electrode site has been reported.’ Since January, 1974, we have used the screw-on spiral type electrode for intrapartum fetal heart rate monitoring in 55 per cent of 394 patients in labor. We had no fetal scalp infections until September. 1974. During the next 5 months, we performed 276 deliveries, of which 54 per cent vyere internally monitored with a spiral type of fetal scalp electrode. Scalp abscesses developed in eight infants who had been monitored. Of these eight scalp infections, seven were severe but none was fatal. Four of the infections were caused by gram-negative rods; bacteroides species were isolated in two of the cases. Our incidence of infection associated with the fetal heart rate monitoring was 5.4 per cent during the epidemic period. In January, 1975, an intensive investigation was instituted to find the causative factors of the epidemic. The electrode used for fetal heart rate monitoring became suspect. We immediately discontinued the use of that model and purchased the model we had used before the epidemic. We have had no further incidences of infant scalp abscesses or complications associated with the electrode.
and Gynecology*
Presented at the Armed Forces Distract Meeting, American College of Obstetricians and Gynecologists, San .4ntonio, Texas, I?owmbu, 1975. The opinion.s and assertions contained herein are the private view of the authors and are not to be construed as ofjcial or as reflecting the views of the Department of the Army or the Department of Defense. Received
for publication
Revised June ‘4ccepted
June
January
12, 1976.
1, 1976. 18, 1976.
Reprin! reqnest.s: Technical Publications Editar. Letterman Army Medical Center, Presidio of San Franrisco. Cahfornia 94129.
720
Scalp abscess with spiral fetal electrode
Table
I. Maternal
721
data
Episiotomy exten.s&t (degree)
I
24
2
22
ll/ 0 6/3O
3
19
2140
Amniotomy Amniotomy
(11) (8)
Leaking on admission A4mniotomy Amniotomy
(14) (10) (8)
19% 7t
35 180
15 9
7
40
6
16+ 15
82 94
14 10
4 .5
24 22
1 O/ 0 71 0
6
28
41 0
Amniotomy
(4)
@
7
26
8/15
.4mniotomy
(8)
8%
180
5
8
21
Spontaneous home (30)
at
17+
87
10
ll/
0
*All mothers were primigravidas except Patient tAugmented by intravenous oxytocin (Pitocin). $One fetal scalp sample.
Table
II. Infant
lll~unt
No.
1, who
1 2
(days)
Gram
14
*I & D = incision and ?Tip of fetal electrode
stain
Negative Gram-negative Negative Gram-positive Gram-negative Negative Gram-positive Unknown
7 3 2 5 2 14 14
3 4 .5 6 7 8
drainage. was recovered
from
case
and materials histories
infant
complications
served
as control.
the
environment
of
of
the
same
The
instruments
and
techniques
period
was
were were
made
examined
and and
analyzed.
maternal
Fourth Fourth
Cesarean section ELF
None
Spontaneous
Fourth
2. All mothers
Fourth
were
Culture
para
XOll
