Skip to main content Accessibility help
×
Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-25T17:45:55.834Z Has data issue: false hasContentIssue false

Chapter 4 - Intrapartum Fetal Monitoring

Published online by Cambridge University Press:  27 January 2017

Sir Sabaratnam Arulkumaran
Affiliation:
St George's Hospital Medical School, University of London
Get access

Summary

Image of the first page of this content. For PDF version, please use the ‘Save PDF’ preceeding this image.'
Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

NICE, Intrapartum care: care of healthy women and their babies during childbirth: clinical guideline 190; 2014. www.nice.org.uk.Google Scholar
Mahomed, K, Nyoni, R, Mulambo, T, Kasule, J, Jacobus, E. Randomised controlled trial of intrapartum fetal heart rate monitoring. BMJ. 1994; 308: 497500.CrossRefGoogle ScholarPubMed
Herbst, A, Ingemarsson, I. Intermittent versus continuous electronic monitoring in labour: a randomised study. Br J Obstet Gynaecol. 1994; 101: 663–8.CrossRefGoogle ScholarPubMed
Ingemarsson, I, Arulkumaran, S, Ingemarsson, E, TambyRaja, RL, Ratnam, SS. Admission test: a screening test for fetal distress in labour. Obstet Gynecol. 1986; 68: 800–6.Google Scholar
Ingemarsson, I, Arulkumaran, S, Paul, RH, Ingemarsson, E, TambyRaja, RL, Ratnam, SS. Fetal acoustic stimulation in early labour in patients screened with the admission test. Am J of Obstet Gynecol. 1988; 158: 7074.CrossRefGoogle Scholar
Impey, L, Reynolds, M, MacQuillan, K, et al. Admission cardiotocography: a randomised controlled trial. Lancet. 2003; 361: 465–70.Google ScholarPubMed
Mires, G, Williams, F, Howie, P. Randomised controlled trial of cardiotocography versus Doppler auscultation of fetal heart at admission in labour in low risk obstetric population. BMJ. 2001; 322(7300): 1457–60.CrossRefGoogle ScholarPubMed
Mitchell, K. The effect of the labour electronic fetal monitoring admission test on operative delivery in low-risk women: a randomised controlled trial. Evidence Based Midwifery. 2008; 6(1): 1826.Google Scholar
Bix, E, Reiner, LM, Klovning, A, Oian, P. Prognostic value of the labour admission test and its effectiveness compared with auscultation only: a systematic review. Br J Obstet Gynaecol. 2005; 112: 1595–604.Google ScholarPubMed
Devane, D, Lalor, JG, Daly, S, McGuire, W, Smith, V. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. Cochrane Database Syst Rev. 2012; 15 (2). CD005122. doi: 10.1002/14651858.CD005122.pub4.CrossRefGoogle Scholar
Wood, C, Renou, P, Oats, J, Farrell, E, Beischer, N, Anderson, I. A controlled trial of fetal heart rate monitoring in a low-risk obstetric population. Am J Obstet Gynecol. 1981; 141(5): 527–34.CrossRefGoogle Scholar
MacDonald, D, Grant, A, Sheridan-Pereira, M, Boylan, P, Chalmers, I. The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring. Am J Obstet Gynecol. 1985; 152(5): 524–39.CrossRefGoogle ScholarPubMed
Thacker, SB, Stroup, DF, Peterson, HB. Efficacy and safety of intrapartum electronic fetal monitoring: an update. Obstet Gynecol. 1995; 86(4 Pt 1): 613–20.CrossRefGoogle ScholarPubMed
Grant, A, O'Brien, N, Joy, MT, Hennessy, E, MacDonald, D. Cerebral palsy among children born during the Dublin randomised trial of intrapartum monitoring. Lancet. 1989; 2(8674): 1233–6.Google ScholarPubMed
Vintzileos, AM, Nochimson, DJ, Guzman, ER, Knuppel, RA, Lake, M, Schifrin, BS. Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: a meta-analysis. Obstet Gynecol. 1995; 85(1): 149–55.CrossRefGoogle ScholarPubMed
Alfirevic, Z, Devane, D, Gyte, GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2013; 31(5). CD006066. doi: 10.1002/14651858.CD006066.pub2.CrossRefGoogle Scholar
Steer, P. ABC of labour care: assessment of mother and fetus in labour. BMJ. 1999; 318(7187): 858.CrossRefGoogle ScholarPubMed
Krebs, HB, Petres, RE, Dunn, LJ. Intrapartum fetal heart rate monitoring. V. Fetal heart rate patterns in the second stage of labor. Am J Obstet Gynecol. 1981; 140 (4): 435–9.CrossRefGoogle ScholarPubMed
Nelson, KB, Dambrosia, JM, Ting, TY, Grether, JK. Uncertain value of electronic fetal monitoring in predicting cerebral palsy. NEJM. 1996; 334(10): 613–19.CrossRefGoogle ScholarPubMed
Gilstrap, LC, Hauth, JC, Toussaint, S. Second stage fetal heart rate abnormalities and neonatal acidosis. Obstet Gynecol. 1984; 63: 209–13.Google ScholarPubMed
Cahill, AG, Caughey, AB, Roehl, KA, Odibo, AO, Macones, GA. Terminal fetal heart decelerations and neonatal outcomes. Obstet Gynecol. 2013; 122(5): 1070–6.CrossRefGoogle ScholarPubMed
Roy, KK, Baruah, J, Kumar, S, et al. Cesarean section for suspected fetal distress, continuous fetal heart monitoring and decision to delivery time. Ind J Pediatr. 2008; 75(12): 1249–52.CrossRefGoogle ScholarPubMed
Gilstrap, LC, Hauth, JC, Hankins, GD, Beck, AW. Second-stage fetal heart rate abnormalities and type of neonatal acidemia. Obstet Gynecol. 1987; 70(2): 191–5.Google ScholarPubMed
Sheiner, E, Hadar, A, Hallak, M, et al. Clinical significance of fetal heart rate tracings during the second stage of labor. Obstet Gynecol. 2001; 97(5): 747–52.Google ScholarPubMed
NICE. Intrapartum care: care of healthy women and their babies during childbirth; 2007. www.publications.nice.org.uk/intrapartum-care-cg55. This guideline is an update of ‘The use of electronic fetal monitoring: the use and interpretation of cardiotocography in intrapartum fetal surveillance’ (Guideline C) issued in May 2001.Google Scholar
Samueloff, A, Langer, O, Berkus, M, et al. Is fetal heart rate variability a good predictor of fetal outcome? Acta Obstet Gynecol Scand. 1994; 73(1): 3944.CrossRefGoogle ScholarPubMed
Spencer, JA, Johnson, P. Fetal heart rate variability changes and fetal behavioral cycles during labour. Br J Obstet Gynaecol. 1986; 93(4): 314–21.Google ScholarPubMed
Cahill, AG, Roehl, KA, Odibo, AO, Macones, GA. Association and prediction of neonatal acidemia. Am J Obstet Gynecol. 2012; 207(3): 206-e1–8.CrossRefGoogle ScholarPubMed
Maso, G, Businelli, C, Piccoli, M, et al. The clinical interpretation and significance of electronic fetal heart rate patterns 2 h before delivery: an institutional observational study. Arch Gynecol Obstet. 2012; 286(5): 1153–9.CrossRefGoogle ScholarPubMed
Williams, KP, Galerneau, F. Intrapartum fetal heart rate patterns in the prediction of neonatal acidemia. Am J Obstet Gynecol. 2003; 188(3): 820–3.CrossRefGoogle ScholarPubMed
Schifrin, BS. The CTG and the timing and mechanism of fetal neurological injuries. Best Pract Res Clin Obstet Gynaecol. 2004; 18(3): 437–56.CrossRefGoogle ScholarPubMed
NICHD. Electronic fetal heart rate monitoring: research guidelines for interpretation. National Institute of Child Health and Human Development Research Planning Workshop. Am J Obstet Gynecol. 1997;177(6): 1385–90.Google Scholar
Krebs, HB, Petres, RE, Dunn, LJ, Smith, PJ. Intrapartum fetal heart rate monitoring. VII. The impact of mode of delivery on fetal outcome. Am J Obstet Gynecol. 1982; 143(2): 190–4.CrossRefGoogle ScholarPubMed
Powell, OH, Melville, A, MacKenna, J. Fetal heart rate acceleration in labor: excellent prognostic indicator. Am J Obstet Gynecol. 1979; 134(1): 36–8.Google ScholarPubMed
Macones, GA, Hankins, GDV, Spong, CY, Hauth, J, Moore, T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. J Obstet Gynecol Neonatal Nurs. 2008; 37(5): 510–15.CrossRefGoogle ScholarPubMed
Spencer, JAD, Badawi, N, Burton, P, et al. The intrapartum CTG prior to neonatal encephalopathy at term: a case‐control study. BJOG. 1997; 104(1): 25–8.CrossRefGoogle ScholarPubMed
Cibils, LA. Clinical significance of fetal heart rate patterns during labor. II. Late decelerations. Am J Obstet Gynecol. 1975; 123(5): 473–94.CrossRefGoogle ScholarPubMed
Krebs, HB, Petres, RE, Dunn, LJ, Jordaan, HV, Segreti, A. Multifactorial analysis of intrapartum fetal heart rate tracings. Am J Obstet Gynecol. 1979; 133(7): 773–80.CrossRefGoogle ScholarPubMed
Low, JA, Victory, R, Derrick, EJ. Predictive value of electronic fetal monitoring for intrapartum fetal asphyxia with metabolic acidosis. Obstet Gynecol. 1999; 93(2): 285–91.Google ScholarPubMed
Ellison, PH, Foster, M, Sheridan-Pereira, M, MacDonald, D. Electronic fetal heart monitoring, auscultation, and neonatal outcome. Am J Obstet Gynecol. 1991; 164(5): 1281–9.CrossRefGoogle ScholarPubMed
Sameshima, H, Ikenoue, T. Predictive value of late decelerations for fetal acidemia in unselective low-risk pregnancies. Am J Perinatol. 2005; 22(1): 1923.CrossRefGoogle ScholarPubMed
Skupski, DW, Rosenberg, CR, Eglinton, GS. Intrapartum fetal stimulation tests: a meta-analysis. Obstet Gynecol. 2002; 99(1): 129–34.Google ScholarPubMed
Roy, KK, Baruah, J, Kumar, S, et al. Cesarean section for suspected fetal distress, continuous fetal heart monitoring and decision to delivery time. Indian J Pediatr. 2008; 75(12): 1249–52. doi: 10.1007/s12098-008-0245-9.CrossRefGoogle ScholarPubMed
Westgate, JA, Wibbens, B, Bennet, L, et al. The intrapartum deceleration in center stage: a physiologic approach to the interpretation of fetal heart rate changes in labor. Am J Obstet Gynecol. 2007; 197(3): 236-e1–11.CrossRefGoogle Scholar
Aldrich, CJ, D'Antona, D, Spencer, JAD, et al. Fetal heart rate changes and cerebral oxygenation measured by near infrared spectroscopy during the first stage of labour. Eur J Obstet Gynaecol Reprod Biol. 1996; 64(2): 189–95.CrossRefGoogle ScholarPubMed
Ball, RH, Parer, JT. The physiologic mechanisms of variable decelerations. Am J Obstet Gynecol. 1992; 166(6): 1683–9.CrossRefGoogle ScholarPubMed
Fleischer, A, Schulman, H, Jagani, N, Mitchell, J, Randolph, G. The development of fetal acidosis in the presence of an abnormal fetal heart rate tracing. I. The average for gestational age fetus. Am J Obstet Gynecol. 1982; 144(1): 5560.CrossRefGoogle ScholarPubMed
Gaziano, EP. A study of variable decelerations in association with other heart rate patterns during monitored labor. Am J Obstet Gynecol. 1979; 135(3): 360–3.CrossRefGoogle ScholarPubMed
Tortosa, MN, Acien, P. Evaluation of variable decelerations of fetal heart rate with the deceleration index: influence of associated abnormal parameters and their relation to the state and evolution of the newborn. Eur J Obstet Gynaecol Reprod Biol. 1990; 34(3): 235–45.CrossRefGoogle Scholar
Morris, RK, Malin, G, Robson, SC, et al. Fetal umbilical artery Doppler to predict compromise of fetal/neonatal wellbeing in a high‐risk population: systematic review and bivariate meta‐analysis. Ultrasound Obstet Gynecol. 2011; 37(2): 135–42.CrossRefGoogle Scholar
Hamilton, E, Warrick, P, O'Keeffe, D. Variable decelerations: do size and shape matter? J Matern Fetal Neonatal Med. 2012; 25(6): 648–53.CrossRefGoogle ScholarPubMed
Özden, S, Demirci, F. Significance for fetal outcome of poor prognostic features in fetal heart rate traces with variable decelerations. Arch Gynecol Obstet. 1999; 262(3–4): 141–9.Google ScholarPubMed
Parer, JT, Livingston, EG. What is fetal distress? Am J Obstet Gynecol. 1990; 162(6): 1421–7.CrossRefGoogle ScholarPubMed
Katz, M, Wilson, SJ, Young, BK. Sinusoidal fetal heart rate. II. Continuous tissue pH studies. Am J Obstet Gynecol. 1980; 136(5): 594–6.CrossRefGoogle ScholarPubMed
Johnson, TR, Compton, AA, Rotmensch, J, Work Johnson, BA , JW. Significance of the sinusoidal fetal heart rate pattern. Am J Obstet Gynecol. 1981; 139(4): 446–53.CrossRefGoogle ScholarPubMed
Young, BK, Katz, M, Wilson, SJ. Sinusoidal fetal heart rate. I. Clinical significance. Am J Obstet Gynecol. 1980; 136(5): 587–93.CrossRefGoogle ScholarPubMed
Winkler, CL, Hauth, JC, Martin Tucker, J, Owen, J, Brumfield, CG. Neonatal complications at term as related to the degree of umbilical artery acidemia. Am J Obstet Gynecol. 1991; 164(2): 637–41.CrossRefGoogle Scholar
Thorp, JA, Trobough, T, Evans, R, Hedrick, J, Yeast, JD. The effect of maternal oxygen administration during the second stage of labor on umbilical cord blood gas values: a randomized controlled prospective trial. Am J Obstet Gynecol. 1995; 172(2): 465–74.CrossRefGoogle ScholarPubMed
Fawole, B, Hofmeyr, GJ. Maternal oxygen administration for fetal distress. Cochrane Database Sys Rev. 2012; 12. CD000136. doi: 10.1002/14651858.CD000136.pub2.Google ScholarPubMed
McNamara, H, Johnson, N, Lilford, R. The effect on fetal arteriolar oxygen saturation resulting from giving oxygen to the mother measured by pulse oximetry. BJOG. 1993; 100(5): 446–9.CrossRefGoogle Scholar
Westgren, M, Kruger, K, Ek, S, et al. Lactate compared with pH analysis at fetal scalp blood sampling: a prospective randomised study. BJOG. 1998; 105(1): 2933.CrossRefGoogle Scholar
Kruger, K, Hallberg, B, Blennow, M, Kublickas, M, Westgren, M. Predictive value of fetal scalp blood lactate concentration and pH as markers of neurologic disability. Am J Obstet Gynecol. 1999; 181(5): 1072–8.CrossRefGoogle ScholarPubMed
Herbst, A, Wölner-Hanssen, P, Ingemarsson, I. Risk factors for acidemia at birth. Obstet Gynecol. 1997; 90(1): 125–30.CrossRefGoogle ScholarPubMed
Low, JA. Intrapartum fetal asphyxia: definition, diagnosis, and classification. Am J Obstet Gynecol. 1997; 176(5): 957–9.CrossRefGoogle ScholarPubMed
Nordström, L. Fetal scalp and cord blood lactate. Best Pract Res Clin Obstet Gynaecol. 2004; 18(3): 467–76.CrossRefGoogle ScholarPubMed
Nordström, L, Achanna, S, Naka, K, Arulkumaran, S. Fetal and maternal lactate increase during active second stage of labour. BJOG. 2001; 108(3): 263–8.Google ScholarPubMed
Krüger, K, Kublickas, M, Westgren, M. Lactate in scalp and cord blood from fetuses with ominous fetal heart rate patterns. Obstet Gynecol. 1998; 92(6): 918–22.Google ScholarPubMed
Rosén, KG, Amer-Wåhlin, I, Luzietti, R, Norén, H. Fetal ECG waveform analysis. Best Pract Res Clin Obstet Gynaecol. 2004; 18(3): 485514.CrossRefGoogle ScholarPubMed
Mansano, RZ, Beall, MH, Ross, MG. Fetal ST segment heart rate analysis in labor: improvement of intervention criteria using interpolated base deficit. J Matern Fetal Neonatal Med. 2007; 20(1): 4752.CrossRefGoogle ScholarPubMed
Vayssiere, C, Haberstich, R, Sebahoun, V, et al. Fetal electrocardiogram ST-segment analysis and prediction of neonatal acidosis. Int J Gynecol Obstet. 2007; 97(2): 110–14.CrossRefGoogle ScholarPubMed
Olofsson, P, Ayres‐de‐Campos, D, Kessler, J, et al. A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part II: the meta‐analyses. Acta Obstet Gynecol Scand. 2014; 93(6): 571–86.Google ScholarPubMed
Dildy, GA. Fetal pulse oximetry. Clin Obstet Gynecol. 2011; 54(1): 6673.CrossRefGoogle ScholarPubMed
Kühnert, M, Seelbach-Göebel, B, Butterwegge, M. Predictive agreement between the fetal arterial oxygen saturation and fetal scalp pH: results of the German multicenter study. Am J Obstet Gynecol. 1998; 178(2): 330–5.CrossRefGoogle ScholarPubMed
Seelbach-Göbel, B, Heupel, M, Kühnert, M, Butterwegge, M. The prediction of fetal acidosis by means of intrapartum fetal pulse oximetry. Am J Obstet Gynecol. 1999; 180(1): 7381.CrossRefGoogle ScholarPubMed
Nonnenmacher, A, Hopp, H, Dudenhausen, J. Predictive value of pulse oximetry for the development of fetal acidosis. J Perinatal Med. 2010; 38(1): 83–6.CrossRefGoogle ScholarPubMed
Dildy, GA, van den Berg, PP, Katz, M, et al. Intrapartum fetal pulse oximetry: fetal oxygen saturation trends during labor and relationship to delivery outcome. In Knitza, R (ed.), Hypoxische Gefährdung des Fetus sub partu (pp. 185–93). Darmstadt: Steinkopff; 1994.Google Scholar
Garite, TJ, Dildy, GA, McNamara, H, et al. A multicenter controlled trial of fetal pulse oximetry in the intrapartum management of non-reassuring fetal heart rate patterns. Am J Obstet Gynecol. 2000; 183(5): 1049–58.CrossRefGoogle Scholar
East, CE, Dunster, KR, Colditz, PB, Nath, CE, Earl, JW. Fetal oxygen saturation monitoring in labour: an analysis of 118 cases. Aust N Z J Obstet Gynaecol. 1997; 37(4): 397401.CrossRefGoogle ScholarPubMed
ACOG Committee. Fetal pulse oximetry: American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Obstet Gynecol. 2001; 98(3): 523–4.Google Scholar
NHS Litigation Authority. Ten Years of Maternity Claims: An Analysis of NHS Litigation Authority Data. London: NHSLA; 2012.Google Scholar
Confidential Enquiry into Stillbirths and Deaths in Infancy. 4th Annual Report. London: Maternal and Child Health Research Consortium; 1997.Google Scholar
Arulkumaran, S, Ingemarsson, I, Montan, S, et al. Traces of You: Fetal Trace Interpretation. Netherlands: Philips Medical Systems; 2002.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×