Skip to main content Accessibility help
Hostname: page-component-544b6db54f-4nk8m Total loading time: 4.398 Render date: 2021-10-24T23:25:24.922Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Book contents

Chapter 63 - Fetal Compromise in Labor (Content last reviewed: 15th December 2018)

from Section 6 - Late Prenatal – Obstetric Problems

Published online by Cambridge University Press:  15 November 2017

David James
University of Nottingham
Philip Steer
Imperial College London
Carl Weiner
University of Kansas
Bernard Gonik
Wayne State University, Detroit
Stephen Robson
University of Newcastle
Get access


For many years it was taken to indicate the presence of hypoxia, leading to fetal acidosis. However, we have become more aware of the importance to the fetus of variables such as maternal/fetal temperature, chorioamnionitis, passage of meconium into the amniotic fluid (which can lead to meconium aspiration syndrome), and trauma, including events such as cord prolapse and head compression (which can occur from excessive molding even in spontaneous labor, but is more commonly associated with forceps and difficult cesarean deliveries).

High-Risk Pregnancy
Management Options
, pp. 1788 - 1809
Publisher: Cambridge University Press
First published in: 2017

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.)


Greenwell, EA, Wyshak, G, Ringer, SA, et al. Intrapartum temperature elevation, epidural use, and adverse outcome in term infants. Pediatrics 2012; 129: e447–54.
Hulthen, V,I, Petersson, K, Kublickas, M, Papadogiannakis, N. Both acute and chronic placental inflammation are overrepresented in term stillbirths: a case-control study. Infect Dis Obstet Gynecol 2012; 2012: 293867.
Balchin, I, Whittaker, JC, Lamont, RF, Steer, PJ. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol 2011; 117: 828–35.
Singh, M, Varma, R. Reducing complications associated with a deeply engaged head at caesarean section: a simple instrument. Obstetrician & Gynaecologist 2008; 10: 3841.
Steer, P. Has the expression “fetal distress” outlived its usefulness? Br J Obstet Gynaecol 1982; 89: 690–3.
Addy, DP. Birth asphyxia. Br Med J 1982; 284: 1288–9.
Towell, M. Fetal acid base physiology and intrauterine asphyxia. In Goodwin, JW, Godden, JO, Chance, GW (eds), Perinatal Medicine, the Basic Science Underlying Clinical Practice. Baltimore, MD: Williams & Wilkins, 1976, pp. 187208.
Beard, RW, Morris, ED, Clayton, SG. pH of foetal capillary blood as an indicator of the condition of the foetus. J Obstet Gynaecol Br Commonw 1967; 74: 812–22.
American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 348, November 2006: Umbilical cord blood gas and acid–base analysis. ACOG Committee on Obstetric Practice. Obstet Gynecol 2006; 108: 1319–22.
Sykes, GS, Molloy, PM, Johnson, P, et al. Do Apgar scores indicate asphyxia? Lancet 1982; i: 494–5.
Lissauer, TJ, Steer, PJ. The relation between the need for intubation at birth, abnormal Cardiotocograms in labour and cord artery blood gas and pH values. Br J Obstet Gynaecol 1986; 93: 1060–6.
Bennet, L, Westgate, JA, Liu, YC, Wassink, G, Gunn, AJ Fetal acidosis and hypotension during repeated umbilical cord occlusions are associated with enhanced chemoreflex responses in near-term fetal sheep. J Appl Physiol 2005; 99: 1477–82.
Westgate, JA, Wibbens, B, Bennet, L, et al. The intrapartum deceleration in center stage: a physiologic approach to the interpretation of FHR changes in labor. Am J Obstet Gynecol 2007; 197: 236.e1–11
National Institute for Health and Care Excellence. Intrapartum Care for Healthy Women and Babies. NICE Clinical Guideline CG190. London: NICE, 2017. (accessed September 2018).
American College of Obstetricians and Gynecologists. Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation and General Management Principles. ACOG Practice Bulletin No. 106. Washington, DC: ACOG, 2009.
Steer, PJ, Eigbe, F, Lissauer, TJ, Beard, RW. Interrelationships among abnormal cardiotocograms in labor, meconium staining of the amniotic fluid, arterial cord blood pH and Apgar scores. Obstet Gynecol 1989; 74: 715–21.
Wheeler, T, Murrills, A. Patterns of FHR during normal pregnancy. Br J Obstet Gynaecol 1978; 85: 1827.
Westgate, JA, Bennet, L, Gunn, AJ. FHR variability changes during brief repeated umbilical cord occlusion in near term fetal sheep. Br J Obstet Gynaecol 1999; 106: 664–71
Badawi, N, Kurinczuk, JJ, Keogh, JM, et al. Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 1998; 317: 1554–8.
McNamara, H, Johnson, N. The effect of uterine contractions on fetal oxygen saturation. Br J Obstet Gynaecol 1995; 102: 644–7
Simpson, KR, James, DC. Effects of oxytocin-induced uterine hyperstimulation during labor on fetal oxygen status and FHR patterns. Am J Obstet Gynecol 2008; 199: 34.e1–5
Peebles, DM, Spencer, JA, Edwards, AD, et al. Relation between frequency of uterine contractions and human fetal cerebral oxygen saturation studied during labour by near infrared spectroscopy. Br J Obstet Gynaecol 1994; 101: 44–8
Skupski, DW, Rosenberg, CR, Eglinton, GS. Intrapartum fetal stimulation tests: a meta-analysis. Obstet Gynecol 2002; 99: 129–34
Vintzileos, AM, Nochimson, DJ, Guzman, ER, et al. Intrapartum electronic FHR monitoring versus intermittent auscultation: a meta-analysis. Obstet Gynecol 1995; 85: 149–55.
Thacker, SB, Stroup, DF. Continuous electronic heart rate monitoring for fetal assessment during labor. Cochrane Database Syst Rev 2000; (2): CD000063.
Alfirevic, Z, Devane, D, Gyte, GM Cuthbert, A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2017; (2): CD006066.
East, CE, Leader, LR, Sheehan, P, Henshall, NE, Colditz, PB. Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring FHR trace. Cochrane Database Syst Rev 2010; (3): CD006174.
Briozzo, L, Martinez, A, Nozar, M, et al. Tocolysis and delayed delivery versus emergency delivery in cases of non-reassuring fetal status during labor. J Obstet Gynaecol Res 2007;33: 266–73.
Neilson, JP. Fetal electrocardiogram (ECG) for fetal monitoring during labour. Cochrane Database Syst Rev 2015; (12): CD000116.
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: 571–86
Doria, V, Papageorghiou, AT, Gustafsson, A, et al. Review of the first 1502 cases of ECG-ST waveform analysis during labour in a teaching hospital. BJOG 2007; 114: 1202–7.
Chandraharan, E. Foetal electrocardiograph (ST-analyser or STAN) for intrapartum foetal heart rate monitoring: a friend or a foe? J Matern Fetal Neonatal Med 2017 Jan 23: 1–8. doi: 10.1080/14767058.2016.1276559. [Epub ahead of print]
Mozurkewich, E, Wolf, FM. Near-infrared spectroscopy for fetal assessment during labour. Cochrane Database Syst Rev 2000; (3): CD002254.
Belfort, MA, Saade, GR, Thom, E, et al. A randomized trial of intrapartum fetal ECG ST-segment analysis. N Engl J Med 2015; 373: 632–41.
Xodo, S, Saccone, G, Schuit, E, Amer-Wåhlin, I, Berghella, V. Why STAN might not be dead. J Matern Fetal Neonatal Med 2016 Nov 2:1–3. [Epub ahead of print]
Bhide, A, Chandraharan, E, Acharya, G. Fetal monitoring in labor: implications of evidence generated by new systematic review. Acta Obstet Gynecol Scand 2016; 95: 58.
Blix, E, Brurberg, KG, Reierth, E, Reinar, LM, Øian, P. ST waveform analysis vs. cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta-analysis of randomized trials. Acta Obstet Gynecol Scand 2015; 95: 1627.
Nickelsen, C, Thomsen, SG, Weber, T. Continuous acid-base assessment of the human fetus during labour by tissue pH and transcutaneous carbon dioxide monitoring. Br J Obstet Gynaecol 1985; 92:220225.
East, CE, Begg, L, Colditz, PB, Lau, R. Fetal pulse oximetry for fetal assessment in labour. Cochrane Database Syst Rev 2014; (10): CD004075.
Ennis, M, Vincent, CA. Obstetric accidents: a review of 64 cases. BMJ 1990; 300: 1365–7.
Vincent, CA, Martin, T, Ennis, M. Obstetric accidents: the patient’s perspective. Br J Obstet Gynaecol 1991; 98: 390–5.
Maternal and Child Health Research Consortium. Confidential Enquiry Into Stillbirths and Deaths in Infancy (CESDI) 6th Annual Report. London: MCHRC, 1999.
NHS Litigation Authority. Study of Stillbirth Claims. London: NHSLA, 2009. (accessed March 2007).
Keith, RD, Beckley, S, Garibaldi, JM, et al. A multicentre comparative study of 17 experts and an intelligent computer system for managing labour using the cardiotocogram. Br J Obstet Gynaecol 1995; 102: 688700.
INFANT Collaborative Group. Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial. Lancet 2017; 389: 1719–29.
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: 524–39.
Nunes, I, Ayres-de-Campos, D, Ugwumadu, A, et al. Central fetal monitoring with and without computer analysis: a randomized controlled trial. Obstet Gynecol 2017; 129: 8390.
Royal College of Obstetricians and Gynaecologists. Each Baby Counts. (accessed September 2018).
Balchin, I, Whittaker, JC, Patel, RR, Lamont, RF, Steer, PJ. Racial variation in the association between gestational age and perinatal mortality: prospective study. BMJ 2007; 334: 833.
Balchin, I, Whittaker, JC, Lamont, RF, Steer, PJ. Timing of planned cesarean delivery by racial group. Obstet Gynecol 2008; 111: 659–66.
Patel, RR, Steer, P, Doyle, P, Little, MP, Elliott, P. Does gestation vary by ethnic group? A London-based study of over 122,000 pregnancies with spontaneous onset of labour. Int J Epidemiol 2004; 33: 107–13.
Davis, RO, Philips, JB, Harris, BA, Wilson, ER, Huddleston, JF. Fatal meconium aspiration syndrome occurring despite airway management considered appropriate. Am J Obstet Gynecol 1985; 151: 731–6.
Cunningham, AS, Lawson, EE, Martin, RJ, Pildes, RS. Tracheal suction and meconium: a proposed standard of care. J Pediatr 1990; 116: 153–4.
Kelleher, J, Bhat, R, Salas, AA, et al. Oronasopharyngeal suction versus wiping of the mouth and nose at birth: a randomised equivalency trial. Lancet 2013; 382: 326–30.
Frey, HA, Tuuli, MG, Shanks, AL, Macones, GA, Cahill, AG. Interpreting category II FHR tracings: does meconium matter? Am J Obstet Gynecol 2014; 211: 644–8.
Geenes, V, Chappell, LC, Seed, PT, et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology 2014; 59: 1482–91.
Hofmeyr, GJ, Xu, H, Eke, AC. Amnioinfusion for meconium-stained liquor in labour. Cochrane Database Syst Rev 2014; (1): CD000014.
Task Force on Joint Assessment of Prenatal and Perinatal Factors Associated with Brain Disorders. National Institutes of Health report on causes of mental retardation and cerebral palsy. Pediatrics 1985; 76: 457–8.
Gaffney, G, Sellers, S, Flavell, V, Squier, M, Johnson, A. Case–control study of intrapartum care, cerebral palsy, and perinatal death. BMJ 1994; 308: 743–50.
Nelson, KB. Perspective on the role of perinatal asphyxia in neurologic outcome: its role in developmental deficits in children. Can Med Assoc J 1989; 141 (Suppl.): 310.
NHS Resolution. Annual Report and Accounts 2017/18. London: NHS, 2018. (accessed September 2018).
Berglund, S, Grunewald, C, Pettersson, H, Cnattingius, S. Severe asphyxia due to delivery-related malpractice in Sweden 1990–2005. BJOG 2008; 115: 316–23.
Beckley, S, Stenhouse, E, Greene, K. The development and evaluation of a computer-assisted teaching programme for intrapartum fetal monitoring. BJOG 2000; 107: 1138–44.
Barrett, JM. Funic reduction for the management of umbilical cord prolapse. Am J Obstet Gynecol 1991; 165: 654–7.

Send book to Kindle

To send this book to your Kindle, first ensure 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 sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ 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

Send book to Dropbox

To send 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 sending content to Dropbox.

Available formats

Send book to Google Drive

To send 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 sending content to Google Drive.

Available formats