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15 - Intrapartum evaluation of the fetus

from Section 2 - Pregnancy, labor, and delivery complications causing brain injury

Published online by Cambridge University Press:  12 January 2010

By
Israel Hendler  and
Daniel S. Seidman
Edited by
David K. Stevenson ,
William E. Benitz ,
Philip Sunshine ,
Susan R. Hintz  and
Maurice L. Druzin
David K. Stevenson
Affiliation:
Stanford University School of Medicine, California
William E. Benitz
Affiliation:
Stanford University School of Medicine, California
Philip Sunshine
Affiliation:
Stanford University School of Medicine, California
Susan R. Hintz
Affiliation:
Stanford University School of Medicine, California
Maurice L. Druzin
Affiliation:
Stanford University School of Medicine, California
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Summary

Introduction

The preliminary estimate of total births in the USA for 2005 was 4,138,349. Intrapartum fetal heart-rate (FHR) monitoring was used in more than 85% of the deliveries. Fetal heart-rate monitoring was introduced into clinical practice in the 1970s. At that time, obstetric providers and researchers in fetal physiology believed electronic fetal monitoring (EFM) would identify changes in the FHR and/or rhythm that reflect fetal acidosis. It was presumed that detection would be early enough to allow clinical intervention that would prevent perinatal asphyxia. Despite 30 years of widespread use and multiple randomized clinical trials, FHR monitoring has not yet been shown to decrease perinatal mortality other than by decreasing intrapartum fetal deaths. Moreover, some experts believe that the use of EFM leads to over-detection of non-reassuring FHR patterns, thereby directly contributing to the escalating rate of cesarean-section deliveries in the USA, which by 2005 increased to 30.3%. We will review the physiology underlying FHR patterns, and the possible reasons why randomized trials of EFM have so far failed to demonstrate efficacy. The current knowledge that guides interpretation of EFM in the intrapartum period will be discussed, with special emphasis on newer methods for intrapartum fetal surveillance.

Type
Chapter
Information
Fetal and Neonatal Brain Injury , pp. 174 - 186
Publisher: Cambridge University Press
Print publication year: 2009

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