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  • Print publication year: 2008
  • Online publication date: August 2009

6 - Fetal monitoring

Summary

Electronic fetal monitoring (EFM) primary screening test is a highly sensitive test detecting a disease with a low prevalence. The fetal heart rate (FHR) trace or cardiotocograph (CTG) has five recognisable features: uterine activity, baseline FHR, baseline variability, accelerations and decelerations. The National Institute for Health and Clinical Excellence guidelines on EFM recommend that a CTG or FHR trace is classified into one of three groups: normal, suspicious or pathological based on the presence of reassuring and non-reassuring features. Fetal blood sampling (FBS) is used to identify compromised fetuses that need immediate delivery from those that are fine. There is a need for a monitoring system with a high specificity and sensitivity for detecting fetal acidosis and allowing timely and appropriate intervention without putting the fetus at risk. Currently, systems being researched include fetal ECG analysis and fetal oxygen saturation monitoring.
REFERENCES
Nelson, K. B., What proportion of cerebral palsy is related to birth asphyxia?J. Pediatr., 112:4 (1988), 572–4.
Vintzileos, A. M., Nochimson, D. J., Guzman, E. R.et al., Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: a meta-analysis. Obstet. Gynecol., 85:1 (1995), 149–55.
Thacker, S. and Stroup, D., Continuous electronic heart rate monitoring versus intermittent auscultation for assessment during labour. Cochrane Database Syst. Rev., 1999. Issue no. 3.
Modanlou, H. D. and Murata, Y., Sinusoidal heart rate pattern: reappraisal of its definition and clinical significance. J. Obstet. Gynaecol. Res., 30:3 (2004), 169–80.
Clinical Effectiveness Support Unit of the Royal College of Obstetricians and Gynaecologists. The Use and Interpretation of Cardiotocography in Intrapartum Fetal Surveillance – Evidence-based Clinical Guideline 8. (London: Royal College of Obstetricians and Gynaecologists Press, 2001).
ACOG technical bulletin, Fetal heart rate patterns: monitoring, interpretation, and management. Number 207 – July 1995 (replaces No. 132, September 1989). Int. J. Gynaecol. Obstet., 51:1 (1995), 65–74.
Elimian, A., Figueroa, R. and Tejani, N., Intrapartum assessment of fetal well-being: a comparison of scalp stimulation with scalp blood pH sampling. Obstet. Gynecol., 89: 3 (1997), 373–6.
Lazebnik, N., Neuman, M. R., Lysikiewicz, A., Dierker, L. R. and Mann, L. I., Response of fetal heart rate to scalp stimulation related to fetal acid–base status. Am. J. Perinatol., 9:4 (1992), 228–32.
Spencer, J. A., Predictive value of a fetal heart rate acceleration at the time of fetal blood sampling in labour. J. Perinat. Med., 19:3 (1991), 207–15.
Mistry, R. and Neilson, J., Fetal electrocardiogram plus heart rate recording for fetal monitoring during labour. Cochrane Database Syst. Rev., 2 (1999), CD000116.
Strachan, B. K., Wijngaarden, W. J., Sahota, D., Chong, A. and James, D. K., Cardiotocography only versus cardiotocography plus per rectum-interval analysis in intrapartum surveillance: a randomised, multicentre trial. FECG Study Group. Lancet, 355:9202 (2000), 456–9.
Maclachlan, N. A., Spencer, J. A., Harding, K. and Arulkumaran, S., Fetal acidaemia, the cardiotocograph and the T/QRS ratio of the fetal Electrocardiograph in labour. Br. J. Obstet. Gynaecol., 99:1 (1992), 26–31.
Dildy, G. A., Thorp, J. A., Yeast, J. D. and Clark, S. L., The relationship between oxygen saturation and pH in umbilical blood: implications for intrapartum fetal oxygen saturation monitoring. Am. J. Obstet. Gynecol., 175:3 Pt 1 (1996), 682–7.
Confidential Enquiry into Stillbirths and Deaths in Infancy. Seventh Annual Report. 1st January to 31st December 1998. (London: Maternal and Child Health Consortium, 2000).
FURTHER READING
Gauge, S. M. and Henderson, C.Cardiotocograph Made Easy 3rd edn (Edinburgh: Churchill Livingstone, 2005).
James, D. K.Steer, P. J., Weiner, C. P. and Gonis, B., High Risk Pregnancy: Management Options, 3rd Edn (Edinburgh: Saunders, 2006).
Kean, L. H.Baker, P. N. and Edelstone, D. I., Best Practice in Labour Ward Management (Philadelphia: Saunders, 2000).
Mitchell, T., Cardiotocographs: Guidance for Interpretation: the Crimson File: a Selection of Cases Compiled During a Confidential Enquiry (Solihull: West Midlands Perinatal Audit, 1995).