The ESA

Cases reveal potential dangers during skin-to-skin contact for mother and baby following Caesarean section birth

12 Nov 2019

Doctors report babies suckling and grabbing ECG electrodes on mother's chest

Doctors writing in the latest edition of the European Journal of Anaesthesiology (the official journal of the European Society of Anaesthesiology) have reported the potential dangers of allowing skin-to-skin contact for mother and baby in the operating room, following a Caesarean section birth.

Both cases involved the newborn baby coming into contact with the electrodes on the mother's skin which monitor her vital signs during the Caesarean section surgery.

Recent trends in neonatal care promote early skin-to-skin contact between mothers and their child, to improve the delivery experience and the success of breastfeeding, even when delivery is scheduled as a Caesarean section in the operating room.

In the first case, a 37-year-old woman giving birth to her first child, with no history of heart disease, was admitted to the obstetric ward at La Zarzuela University Hospital, Madrid, Spain, to induce labour. After 8 hours, doctors proceeded to a Caesarean section because the baby's head was too large to fit through the mother's pelvis. The mother was given a standard epidural, and her vital signs monitored. Soon after, a healthy baby boy was delivered with no major bleeding.

After initial examination of the baby, he was placed on his mother's chest to provide early SSC. "Shortly after this, the heart rate alarm was triggered on the monitor, due to an apparent dramatic increase of the mother's heart rate," explains report co-author Dr Nicolas Brogly, La Zarzuela University Hospital and La Paz Hospital, Madrid, Spain. "However, the woman remained conscious and with no complaint."

Furthermore, the mother's other vital signs were showing as normal, including her radial pulse which showed no signs of abnormal or high heart rate. Her blood pressure remained normal. The positioning of the electrocardiographic (ECG) electrodes was checked, to investigate potential interference of the baby heart electric activity on the mother's ECG trace. "The newborn was found suckling the right electrode of the ECG, which was immediately replaced to another site on the mother's skin," explains Dr Brogly. "The abnormal ECG rhythm, which was in fact a combination of the mother and the baby's ECG, then disappeared."

The second case was cared for by Dr Leonie Slegers and her team at St Antonius Hospital, Woerden, the Netherlands. This case involved a 36-year-old woman, having her second child. She had been pregnant for 40 weeks and again had no history of heart disease. Despite labour proceeding normally, the baby's head did not descend, and doctors proceeded to a Caesarean section.

The woman remained stable throughout and the operation produced a healthy baby boy who was placed on her chest, with warm blankets put on both of them. Soon after, the ECG changed to an abnormally fast rhythm (tachycardia). The patient still had the baby on her chest, and while her other vital signs were normal, the ECG appeared to contain two different ECG rhythms in one recording.

Dr Slegers says: "A quick inspection of the baby showed that he had taken the right ECG lead in his hand! After carefully moving this to lead to the mother's right shoulder, the ECG returned to normal."

Dr Brogly says: "Both of these cases show that through the baby suckling or touching an ECG electrode, the cardiac electric activity of the baby can merge with the mother's.this novel source of electric interference represents a risk for both the mother and the baby. The alarm on the monitor could have led to a misdiagnosis with of supraventricular arrhythmia, which could then have led to administration of antiarrhythmic drugs, or even worse, using the defibrillator on the mother to stabilise her heart rate."

The authors note that only one case has been reported of electric interference on a labouring woman, using atranscutaneous electrical nerve stimulator (TENS) to treat labour pain.

The authors conclude by saying that all obstetric teams should be fully up-to-date on skin-to-skin contact protocol implementation, including following Caesarean sections. They conclude: "When planning SSC in the operating room, we recommend ECG electrodes should be placed where no contact will be possible with the new baby (at the back of the shoulders for example) to allow cardiac monitoring of the mother while avoiding ECG interference with the child upon skin contact after delivery."  

Dr Nicolas Brogly, La Zarzuela University Hospital and La Paz Hospital, Madrid, Spain. T) +34 663 676 820 E) nicolas0brogly@hotmail.com

Dr Leonie Slegers, St Antonius Hospital, Nieuwegein, the Netherlands. T) +31634004200 E) l.slegers@antoniusziekenhuis.nl

For a photo of case 2 of the baby's hand touching the electrode:

Click here

https://journals.lww.com/ejanaesthesiology/Citation/2019/12000/Skin_to_skin_contact_during_caesarean_delivery__An.11.aspx