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Fetal heart rate monitoring in labour: A critical review

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Hypoxische Gefährdung des Fetus sub partu
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Abstract

Continuous monitoring of the fetal heart rate (FHR) during labour has become widespread since its introduction into clinical practice during the 1960s. However, there has been increasing criticism of its routine use in recent years because of growing doubts about its effectiveness. Although early reports suggested that continuous FHR monitoring in high risk labour was associated with a reduction in the incidence of fetal and neonatal deaths related to labour (23, 36) there has been no evidence to show a similar benefit in terms of perinatal morbidity or long-term neurodevelopmental handicap. If anything, routine use of continuous FHR monitoring has been associated with an increase in operative delivery rates and an increasing rate of medico-legal cases against hospitals. Clearly, early expectations of the value of continuous FHR monitoring have not been realised.

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References

  1. Beard RW, Filshie GM, Knight CA, Roberts GM (1971) The significance of the changes in the continuous fetal heart rate in the first stage of labour. J Obstet Gynaecol Br Commonw 78: 865–881

    Article  PubMed  CAS  Google Scholar 

  2. Bissonnette JM (1975) Relationship between continuous fetal heart rate patterns and Apgar score in the newborn. Br J Obstet Gynaecol 82: 24–28

    Article  Google Scholar 

  3. Chik L, Sokol R, Rosen MG (1976) ’Prediction’ of the one-minute Apgar score from fetal heart rate data. Obstet Gynecol 48: 452–455

    PubMed  CAS  Google Scholar 

  4. Cibils LA (1978) Clinical significance of fetal heart rate patterns during labour V. Variable decelerations. Am J Obstet Gynaecol 132: 791–803

    CAS  Google Scholar 

  5. Curzen P, Bekin JS, McLintock DG, Patel M (1984) Reliability of cardiotocography in predicting baby’s condition at birth. Br Med J 289:1345–1347

    Article  CAS  Google Scholar 

  6. Dennis J, Johnson A, Mutch L, Yudkin P, Johnson P (1989) Acid-base status at birth and neurodevelopmental outcome at four and one-half years. Am J Obstet Gynecol 161: 213–220

    PubMed  CAS  Google Scholar 

  7. Dijxhoorn MJ, Visser GHA, Fidler VJ, Touwen BCL, Huisjes HJ (1986) Apgar score, meconium and acidaemia at birth in relation to neonatal neurological morbidity in term infants. Br J Obstet Gynaecol 93: 217–222

    Article  PubMed  CAS  Google Scholar 

  8. Eskes TKAB, Jongsma HW, Houx PCW (1983) Percentiles for gas values in human umbilical cord blood. Eur J Obstet Gynecol Reprod Biol 14: 341–346

    Article  PubMed  CAS  Google Scholar 

  9. Fee S, Malee K, Deddish R, Minogue JP, Socol ML (1990) Severe acidosis and subsequent neurological status. Am J Obstet Gynecol 162: 802–806

    PubMed  CAS  Google Scholar 

  10. FIGO News (1987) Guidelines for the use of fetal monitoring. Int J Gynaecol Obstet 25:159–167

    Article  Google Scholar 

  11. Fleischer A, Schulman H, Jagani N, Mitchell J, Randolph G (1982) The development of fetal acidosis in the presence of an abnormal fetal heart rate tracing 1. The average for gestational age fetus. Am J Obstet Gynecol 144: 55–60

    PubMed  CAS  Google Scholar 

  12. Gilstrap LC, Hauth JC, Hankins GDV, Beck AW (1987) Second-stage fetal heart rate abnormalities and type of neonatal acidemia. Obstet Gynecol 70:191–195

    PubMed  Google Scholar 

  13. Gilstrap LC, Leveno KJ, Burris J, Williams ML, Little BB (1989) Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction. Am J Obstet Gynecol 161:825–830

    PubMed  Google Scholar 

  14. Giussani DA, Spencer JAD, Moore PJ, Bennet L, Hanson MA (1993) Afferent and efferent components of the cardiovascular reflex responses to acute hypoxia in term fetal sheep. J Physiol 461: 431–449

    PubMed  CAS  Google Scholar 

  15. Goldaber KG, Gilstrap LC, Leveno KJ, Dax JS, McIntire DD (1991) Pathological fetal acidemia. Obstet Gynecol 78:1103–1107

    PubMed  CAS  Google Scholar 

  16. Grant A, O’Brien N, Joy MT, Hennessy E, MacDonald D (1989) Cerebral palsy among children born during the Dublin randomised trial of intrapartum monitoring. Lancet II: 1233–1235

    Article  Google Scholar 

  17. Hammacher K, Huter KA, Bokelmann J, Werners PH (1968) Foetal heart rate frequency and perinatal condition of the foetus and newborn. Gynaecologia 166: 349–360

    PubMed  CAS  Google Scholar 

  18. Heinrich J (1982) Elective fetal monitoring and obstetrical operative frequency. Europ J Obstet Gynecol Reprod Biol 14:143–152

    Article  CAS  Google Scholar 

  19. Hon EH (1968) An atlas of fetal heart rate patterns. Harty Press, New Haven.

    Google Scholar 

  20. Ingemarsson E (1981) Routine electronic fetal monitoring during labour. Acta Obstet Gynecol Scand, suppl 99

    Google Scholar 

  21. James LS, Adamsons K (1964) Respiratory physiology of the fetus and newborn infant. New Eng J Med 271:1352–1409

    Article  PubMed  CAS  Google Scholar 

  22. James LS, Weisbrot IM, Prince CE, Holaday DA, Apgar V (1958) The acid-base status of human infants in relation to birth asphyxia and the onset of respiration. J Pediatr 52: 379–394

    Article  PubMed  CAS  Google Scholar 

  23. Johnstone FD, Campbell DM, Hughes GJ (1978) Has continuous intrapartum monitoring made any impact on fetal outcome? Lancet I:1290–1300

    Google Scholar 

  24. Krebs HB, Petres RE, Dumm LJ, Jordaan HVF, Segreti A (1979) Intrapartum fetal heart rate monitoring. 1 classification and prognosis of fetal heart rate patterns. Am J Obstet Gynecol 133:762–772

    PubMed  CAS  Google Scholar 

  25. Kubli FW, Hon EH, Khazin AF, Takemura H (1969) Observations on heart rate and pH in the human fetus during labour. Am J Obstet Gynecol 104:1190–1206

    PubMed  CAS  Google Scholar 

  26. Liu DTY, Thomas G, Blackwell RJ (1975) Progression in response patterns of fetal heart rate throughout labour. Br J Obstet Gynaecol 82: 943–951

    Article  PubMed  CAS  Google Scholar 

  27. Low JA, Pancham SR, Worthington D, Boston RW (1975) The incidence of fetal asphyxia in six hundred high-risk monitored pregnancies. Am J Obstet Gynecol 121: 456–459

    PubMed  CAS  Google Scholar 

  28. Low JA, Cox MJ, Karchmar EJ, McGrath MJ, Pancham SR, Piercy WN (1981) The prediction of intrapartum fetal metabolic acidosis by fetal heart rate monitoring. Am J Obstet Gynecol 139: 299–305

    PubMed  CAS  Google Scholar 

  29. Low JA, Galbraith RS, Muir DW, Killen HL, Patet EA, Karchmar EL (1983) Intrapartum fetal hypoxia: a study of long-term morbidity. Am J Obstet Gynecol 145:129–134

    PubMed  CAS  Google Scholar 

  30. MacLachlan NA, Spencer JAD, Harding K, Arulkumaran S (1992) Fetal acidaemia, the cardiotocograph and the T/QRS ratio of the fetal ECG in labour. Br J Obstet Gynaecol 99: 26–31

    Article  PubMed  CAS  Google Scholar 

  31. Modanlou H, Yeh S-Y, Hon EH (1974) Fetal and neonatal acid-base balance in normal and high-risk pregnancies. Obstet Gynecol 43: 347–353

    PubMed  CAS  Google Scholar 

  32. Myers RE, Mueller-Heubach E, Adamsons K (1973) Predictability of the state of fetal oxygenation from a quantitative analysis of the components of late deceleration. Am J Obstet Gynecol 115:1083–1094

    PubMed  CAS  Google Scholar 

  33. O’Gureck JE, Roux JF, Neuman MR (1972) Neonatal depression and fetal heart rate patterns during labour. Obstet Gynecol 40: 347–355

    PubMed  Google Scholar 

  34. Painter MJ, Scott M, Hirsch RP, O’Donoghue P, Depp R (1988) Fetal heart rate patterns during labour: neurologic and cognitive development at six to nine years of age. Am J Obstet Gynecol 159: 854–858

    PubMed  CAS  Google Scholar 

  35. Parer JT, Krueger TR, Harris JL (1980) Fetal oxygen consumption and mechanisms of heart rate response during artificially produced late decelerations of fetal heart rate in sheep. Am J Obstet Gynecol 136: 478–482

    PubMed  CAS  Google Scholar 

  36. Paul RH, Hon EH (1974) Clinical fetal monitoring. Am J Obstet Gynecol 118: 529–533

    PubMed  CAS  Google Scholar 

  37. Piquard F, Hsiung R, Mettauer M, Schaeffer A, Haberey P, Dellenbach P (1988) The validity of fetal heart rate monitoring during the second stage fo labour. Obstet Gynecol 72: 746–751

    PubMed  CAS  Google Scholar 

  38. Ruth VJ, Raivio KO (1988) Perinatal brain damage: predictive value of metabolic acidosis and Apgar score. Br Med J 297: 24–27

    Article  CAS  Google Scholar 

  39. Spencer JAD (1989) Fetal heart rate variability. In Progress in Obstetrics and Gynaecology, volume 7 (Studd J ed), Churchill Livingstone, Edinburgh, pp 103–122

    Google Scholar 

  40. Spencer JAD (1991) The predictive value of a fetal heart rate acceleration at the time of fetal blood sampling in labour. J Perinat Med 19: 207–215

    Article  PubMed  CAS  Google Scholar 

  41. Spencer JAD, Johnson P (1986) Fetal heart rate variability changes and fetal behavioural cycles during labour. Br J Obstet Gynaecol 93: 314–321

    PubMed  CAS  Google Scholar 

  42. Spencer JAD, Ward HRT (1993) Intrapartum Fetal Surveillance. Royal College of Obstetricians and Gynaecologists Press, London

    Google Scholar 

  43. Spencer JAD, Koutsoukis M, Lee A (1991) Fetal heart rate and neonatal condition related to epidural analgesia in women reaching the second stage of labour. Eur J Obstet Gynecol Reprod Biol 41:173–178

    Article  PubMed  CAS  Google Scholar 

  44. Spencer JAD, Robson SC, Farkas A (1993) Spontaneous recovery after severe metabolic acidaemia at birth. Early Hum Dev 32:103–111

    Article  PubMed  CAS  Google Scholar 

  45. Sykes GS, Molloy PM, Johnson P, Gu W, Ashworth F, Stirrat GM and Turnbull AC (1982) Do Apgar scores indicate asphyxia? Lancet I: 494–496

    Article  Google Scholar 

  46. Tejani N, Mann LI, Bhakthavathsalan A, Weiss RR (1975) Correlation of fetal heart rate — uterine contraction patterns with fetal scalp blood pH. Obstet Gyncol 46, 392–396

    CAS  Google Scholar 

  47. Tejani N, Mann LI, Bhakthavathsalan A (1976) Correlation of fetal heart rate paterns and fetal pH with neonatal outcome. Obstet Gynecol 48: 460–463

    PubMed  CAS  Google Scholar 

  48. Thacker SB (1991) Effectiveness and safety of intrapartum fetal monitoring. In Fetal Monitoring (Spencer JAD ed), Oxford University Press, Oxford, pp 211–217.

    Google Scholar 

  49. Thorp JA, Sampson JE, Parisi VM, Creasy RK (1989) Routine umbilical cord blood gas determinations. Am J Obstet Gynecol 161: 600–605

    PubMed  CAS  Google Scholar 

  50. Wheble AM, Gillmer MDG, Spencer JAD, Sykes GS (1989) Changes in fetal monitoring practice in the UK: 1977–1984. Br J Obstet Gynaecol 96:1140–1147

    Article  PubMed  CAS  Google Scholar 

  51. Winkler CL, Hauth JC, Tucker JM, Owen J, Brumfield CG (1991) Neonatal complications at term as related to the degree of umbilical artery acidemia. Am J Obstet Gynecol 164: 637–641

    PubMed  CAS  Google Scholar 

  52. Young DC, Gray JH, Luther ER, Peddle LJ (1980) Fetal scalp blood pH sampling: its value in an active obstetric unit. Am J Obstet Gynecol 136: 276–281

    PubMed  CAS  Google Scholar 

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© 1994 Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt

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Spencer, J.A.D. (1994). Fetal heart rate monitoring in labour: A critical review. In: Knitza, R. (eds) Hypoxische Gefährdung des Fetus sub partu. Steinkopff. https://doi.org/10.1007/978-3-642-95982-0_3

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  • DOI: https://doi.org/10.1007/978-3-642-95982-0_3

  • Publisher Name: Steinkopff

  • Print ISBN: 978-3-642-95983-7

  • Online ISBN: 978-3-642-95982-0

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