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The vast majority of pregnant women are subjected to electronic fetal heart monitoring during labor. There is limited evidence to support its benefit compared with intermittent auscultation. In addition, there is significant variability in interpretation and its false-positive rate is high. The latter may have contributed to the rise in operative deliveries. In order to address the critical need for better approaches to intrapartum monitoring, the MFMU Network has completed two large multisite randomized trials, one to evaluate fetal pulse oximetry and the other to evaluate fetal ECG ST segment analysis (STAN). Both of these technologies had been approved for clinical use in the United States based on prior smaller trials. These technologies were evaluated in laboring women near term and their primary outcomes were overall cesarean delivery for the oximetry trial and a composite adverse neonatal outcome for STAN. Both the trials failed to show a benefit of the technology, neither in the rates of operative deliveries nor in the rates of adverse neonatal outcomes. The experience with these trials, summarized in this report, highlights the need for rigorous evidence before introduction of new technology into clinical practice and provides a blueprint for future trials to address the need for better intrapartum monitoring approaches. [ABSTRACT FROM AUTHOR]

The goal of this review is to synthesize the available information regarding factors leading to the first cesarean, especially as it relates to the role of electronic fetal heart rate monitoring (EFM) in the prevention of the first cesarean. The widespread use of EFM did not reduce perinatal or neonatal adverse outcomes. Coupled with its inherent problems, such as poor sensitivity and reliability, this has led to a dramatic increase in cesarean delivery rates. To be realistic in any attempt to lower the current cesarean rate, we must address the inherent limitations in our current EFM methods. [Copyright &y& Elsevier]

Abstract: Intrapartum fetal surveillance is mandatory in every labour. Continuous electronic fetal heart rate monitoring (CEFM) remains the main method used in high-risk clinical situations. Although the use of CEFM has been shown to reduce the incidence of neonatal seizures, it has not reduced the incidence of cerebral palsy or neonatal encephalopathy. CEFM is technically easy to introduce but interpretation is subjective. Inter-observer and intra-observer differences are well recognized in the interpretation of cardiotocograph (CTG) traces. Standardization of interpretation using guidelines and training of staff can improve reliability in interpretation. CEFM should be used as a screening test with the addition of fetal scalp blood sampling (FBS) to confirm fetal acid–base balance. Recent research has focussed on analysis of the ST segment of the fetal electrocardiograph as an adjunct to continuous electronic fetal monitoring. Fetal pulse oximetry techniques have also been considered. [ABSTRACT FROM AUTHOR]

Abstract: Background: The purpose of this study was to compare fetal oxygen saturation by fetal pulse oximetry in parturients with and without epidural labor analgesia in a prospective case control study. Methods: Fetal oxygen saturation values were compared in term pregnant women who received epidural analgesia (epidural group) with those in women who did not (control group). Mode of delivery, Apgar score, fetal oxygen saturation, cord blood gas analysis and fetal outcomes were also compared. Results: A total of 150 pregnant women (75 in each group) gave written consent and were enrolled. The average fetal oxygen saturation during the first stage of labor (active phase) was 45.6 ± 8.1% for the epidural group and 45.9 ± 7.4% for the control group (NS); saturations for the second stage of labor were 44.9 ± 8.8% and 45.3 ± 6.7%, respectively (NS). In the epidural group, the duration of the first stage of labor was significantly longer (565 ± 217 min) than the control group (434 ± 222 min; P= 0.001). Cesarean delivery rates, neonatal cord blood gas analysis, Apgar scores, and neonatal outcomes were similar in the two groups. Conclusions: Fetal oxygen saturation values are similar in the first and second stage of labor in the presence or absence of epidural labor analgesia. [Copyright &y& Elsevier]

Objective: We tested if fetal pulse oximetry in addition to electronic fetal monitoring (CTG) and scalp blood sampling improves the accuracy of fetal assessment and allows safe reduction of operative deliveries (-50%) and scalp blood sampling (-50%) performed because of nonreassuring fetal status. Study design: A randomized controlled trial was conducted in 146 patients with term pregnancies in active labor and abnormal fetal heart rate patterns: 73 had electronic fetal heart rate monitoring (CTG) and fetal scalp blood sampling (control group), 73 had CTG, fetal scalp blood sampling, and continuous fetal pulse oximetry (study group). Results: There was a reduction of -50% in operative deliveries and fetal scalp blood sampling performed because of nonreassuring fetal status in the study group: operative deliveries, study versus control 25/49 (P ≤ .001); fetal scalp sampling, study versus control 32/64 (P ≤ .001). An increase in cesarean sections because of dystocia in the study group did not change the net number of operative deliveries. There was no difference between the 2 groups in adverse maternal or neonatal outcomes, as well as for the end points of metabolic acidosis and need for resuscitation. Conclusion: There was a safe reduction in operative deliveries (-50%) and scalp blood sampling (-50%) performed because of nonreassuring fetal status. The increase in cesarean sections because of dystocia in the study group was a well-documented arrest of labor, but it did not change the total number of operative deliveries in this group. [ABSTRACT FROM AUTHOR]