Electronic intrapartum fetal monitoring: a systematic review of international clinical practice guidelines

Mohan, Manoj; Ramawat, Joohi; Monica, G.; Jayaram, Pradeep; Fattah, Sherif Abdel; Learmont, Jonathan G.; Bryan, Corinna; Zaoui, Safia; Pullattayil, Abdul K.; Konje, Justin C.; Lindow, Stephen W.

doi:10.1016/j.xagr.2021.100008

Cited by 16 publications

(11 citation statements)

References 22 publications

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“…The results indicate that FHR decreases in the last hour before delivery from a median of 136 to 131 bpm. This baseline heart rate falls within the established normal range (110–160), as documented in various guidelines [ 12 ]. In addition, the presented baseline FHR findings fall within category I in the National Institute of Child Health and Human Development classification system, which is strongly predictive of normal acid-base status when other parameters in the same category are normal [ 22 ].…”

Section: Discussionsupporting

confidence: 68%

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Fetal to Neonatal Heart Rate Transition during Normal Vaginal Deliveries: A Prospective Observational Study

et al. 2023

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Documentation of fetal to neonatal heart rate (HR) transition is limited. The aim of the current study was to describe HR changes from one hour before to one hour after normal vaginal deliveries. We conducted a prospective observational cohort study in Tanzania from 1 October 2020 to 30 August 2021, including normal vaginal deliveries with normal neonatal outcomes. HR was continuously recorded from one hour before to one hour after delivery, using the Moyo fetal HR meter, NeoBeat newborn HR meter, and the Liveborn Application for data storage. The median, 25th, and 75th HR percentiles were constructed. Overall, 305 deliveries were included. Median (interquartile range; IQR) gestational age was 39 (38–40) weeks and birthweight was 3200 (3000–3500) grams. HR decreased slightly during the last 60 min before delivery from 136 (123,145) to 132 (112,143) beats/minute. After delivery, HR increased within one minute to 168 (143,183) beats/min, before decreasing to around 136 (127,149) beats/min at 60 min after delivery. The drop in HR in the last hour of delivery reflects strong contractions and pushing. The rapid increase in initial neonatal HR reflects an effort to establish spontaneous breathing.

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Section: Discussionsupporting

confidence: 68%

“…Guidelines derived from different studies and professional bodies are in agreement on recommending a baseline FHR of 110–160 beats per minute (bpm) during pregnancy and delivery [ 12 ]. However, during delivery, the first and second stages of labor are different in terms of physiology.…”

Section: Introductionmentioning

confidence: 99%

Fetal to Neonatal Heart Rate Transition during Normal Vaginal Deliveries: A Prospective Observational Study

et al. 2023

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“…[7,8] There are different guidelines worldwide for CTG interpretation. [9] There is not only substantial inter-observer disagreement using individual guidelines but also poor agreement when comparison is made across different guidelines. [10,11] Furthermore, some experts argue that looking at CTG on the basis of pattern recognition alone with emphasis on FHR decelerations results in unnecessary interventions for non-acidotic babies who mount normal responses to hypoxia and has no correlation with neonatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

Physiological CTG categorization in types of hypoxia compared with MRI and neurodevelopmental outcome in infants with HIE

Pereira

Patel

Zaima

et al. 2022

The Journal of Maternal-Fetal & Neonatal Medicine

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“…Cited weaknesses of the technique include subjective interpretation of tracings, poor intra-and inter-observer agreement, insufficient sensitivity and specificity, and poor correlation with fetal acidemia (4,5). Using current classifications of patterns, with their contradictions (6), CTG has not seemed to reduce the overall incidence of permanent intrapartum-linked neurological injury, although it may have lowered the incidence of neonatal hypoxic-ischemic encephalopathy (HIE) and seizures (7,8). Long-term studies suggest a temporal improvement in outcome with the introduction of enhanced CTG techniques, but cannot attribute the improvement specifically to CTG (9).…”

Section: Introductionmentioning

confidence: 99%

Approaches to Preventing Intrapartum Fetal Injury

et al. 2022

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Electronic fetal monitoring (EFM) was introduced into obstetric practice in 1970 as a test to identify early deterioration of fetal acid-base balance in the expectation that prompt intervention (“rescue”) would reduce neonatal morbidity and mortality. Clinical trials using a variety of visual or computer-based classifications and algorithms for intervention have failed repeatedly to demonstrate improved immediate or long-term outcomes with this technique, which has, however, contributed to an increased rate of operative deliveries (deemed “unnecessary”). In this review, we discuss the limitations of current classifications of FHR patterns and management guidelines based on them. We argue that these clinical and computer-based formulations pay too much attention to the detection of systemic fetal acidosis/hypoxia and too little attention not only to the pathophysiology of FHR patterns but to the provenance of fetal neurological injury and to the relationship of intrapartum injury to the condition of the newborn. Although they do not reliably predict fetal acidosis, FHR patterns, properly interpreted in the context of the clinical circumstances, do reliably identify fetal neurological integrity (behavior) and are a biomarker of fetal neurological injury (separate from asphyxia). They provide insight into the mechanisms and trajectory (evolution) of any hypoxic or ischemic threat to the fetus and have particular promise in signaling preventive measures (1) to enhance the outcome, (2) to reduce the frequency of “abnormal” FHR patterns that require urgent intervention, and (3) to inform the decision to provide neuroprotection to the newborn.

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Electronic intrapartum fetal monitoring: a systematic review of international clinical practice guidelines

Cited by 16 publications

References 22 publications

Fetal to Neonatal Heart Rate Transition during Normal Vaginal Deliveries: A Prospective Observational Study

Fetal to Neonatal Heart Rate Transition during Normal Vaginal Deliveries: A Prospective Observational Study

Physiological CTG categorization in types of hypoxia compared with MRI and neurodevelopmental outcome in infants with HIE

Approaches to Preventing Intrapartum Fetal Injury

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