Intrapartum Fetal Monitoring

Abstract

Intrapartum fetal monitoring to assess fetal well-being during the labor and delivery process has been a central component of intrapartum care for decades. Today, electronic fetal monitoring (EFM) is the most common method used to assess the fetus during labor without substantial evidence to suggest a benefit. A Cochrane review of 13 trials, which included over 37,000 women, found that continuous EFM provided no significant improvement in perinatal death rate [risk ratio (RR) 0.86; 95% confidence interval (CI), 0.59-1.23] or cerebral palsy rate (RR 1.75; 95% CI, 0.84-3.63) as compared with intermittent auscultation; however, there was a significant decrease in neonatal seizures (RR 0.50; 95% CI, 0.31-0.80). In addition, there was a significant increase in cesarean delivery (RR 1.63; 95% CI, 1.29-2.07) and operative vaginal delivery (RR 1.15; 95% CI, 1.01-1.33). Despite the lack of scientific support to suggest that EFM reduces adverse neonatal outcomes, its use is almost universal in the hospital setting and very likely has contributed to the rise in cesarean rate.

Umbilical cord arterial blood gas analysis in term singleton pregnancies: a retrospective analysis over 11 years

“…Antepartum risk factors include prior caesarean delivery, maternal age 35 years or older, prior neonatal death, single civil status, and short stature [19]. Intrapartum risk factors include the use of oxytocin, tachysystole, meperidine use, uterine rupture, cord complications, clinical indication of chorioamnionitis, meconium-stained amniotic fluid, breech presentation, operative delivery, and abnormal FHR during labor [10,[19][20][21][22][23][24]. Our data also confirmed the antepartum factors of lower maternal height and weight, primiparity, lower neonatal birth weight, and SGA as risk factors for low cord pH.…”

A new microdialysis probe for continuous lactate measurement during fetal monitoring: Proof of concept in an animal model

“…These include STsegment analysis of the fetal electrocardiography, fetal pulse oximetry, and near-infrared spectroscopy. 3,8 However, a convincing significant benefit over CTG has not been shown for any of these methods. [9][10][11] Therefore, a method for intrapartum fetal monitoring that more accurately discriminates between absence and presence of hypoxia should be developed.…”

Elevated umbilical cord arterial lactate at birth and electronic fetal monitoring characteristics on admission and in the active phase

“…Despite these potential limitations, the widespread adoption of EFM deserves evidence-based attention. EFM has never been shown in randomized studies to have a positive impact on significant neonatal outcomes [12]. However, it seems unlikely that obstetric providers will abandon this monitoring modality, and therefore it is essential to maximize its utility to improve neonatal outcomes and to reduce unnecessary interventions including cesarean delivery [12, 13].…”