Penetration of the subarachnoid space by fetal scalp electrode.

Penetration of the subarachnoid space by fetal scalp electrode Fetal scalp electrodes of various designs are used widely for continuous intrapartum fetal heart rate monitoring. Minor lacerations of the scalp are common, and 1-0-4-5% of infants may develop scalp ulceration or abscess.1 2 We describe two cases in which there was penetration of the subarachnoid space with leakage of cerebrospinal fluid associated with the use of a scalp electrode of the single helix type. Case reports Case 1-A 20 year old primigravida was admitted in spontaneous labour at 38 weeks of gestation. A fetal scalp electrode was applied at 4 cm cervical dilatation with the fetal head in the left occipitoanterior position. Spontaneous vaginal delivery of a mature boy weighing 3130 g occurred four hours later. The baby was in good condition with Apgar scores of 9 and 10 at one and five minutes respectively. Three hours after delivery we noted leakage of clear cerebrospinal fluid from the scalp electrode site over the posterior fontanelle. Conservative treatment with a dry dressing, prophylac-tic antibiotics, and nursing of the baby in a sitting position resulted in resolution of the leak within 48 hours without any apparent complications. Case 2-A 20 year old primigravida was admitted in spontaneous labour at 39 weeks. A fetal scalp electrode was applied at 3 cm cervical dilatation with the fetal head in the right occipitoanterior position. Spontaneous vaginal delivery of a mature girl weighing 3050 g occurred seven hours later. The baby was in good condition with Apgar scores of 9 and 10 at one and five minutes. Routine examination after birth disclosed leakage of clear fluid from the electrode site over the right parietal bone, 2-5 cm behind the posterior edge of the anterior fontanelle. As in case 1 there was rapid resolution of the leak (in this case within 24 hours) without any neurological complications.