Fetal Compromise in Labor

We have re-engineered management of labor/delivery/ and the newborn to significantly reduce neonatal compromise and medicolegal exposures.

Mark I. Evans (Author), Lawrence D. Devoe (Author), Philip J. Steer (Author)

9781009466301, Cambridge University Press

Paperback / softback, published 13 February 2025

76 pages
22.9 x 15.2 x 0.4 cm, 0.137 kg

Sixty years ago, the purpose of introducing electronic fetal heart rate monitoring (EFM) was to reduce the incidence of intrapartum stillbirth. However, by the early 1980s, with falling stillbirth rates, fetal blood sampling had been widely abandoned, as many considered that EFM was sufficient on its own. Unfortunately, while the sensitivity of EFM for the detection of potential fetal compromise is high, specificity is low, and there is a high false positive rate which has been associated with a rising cesarean section rate. The authors suggest that EFM is considered and analyzed as a classic screening test and not a diagnostic test. Furthermore, it requires contextualization with other risk factors to achieve improved performance. A new proposed metric, the Fetal Reserve Index, takes into account additional risk factors and has demonstrated significantly improved performance metrics. It is going through the phases of further development, evaluation, and wider clinical implementation.

Introduction
The Physiology and Pathophysiology of Heart Rate Patterns
Traditional Diagnostics
Alternative Approaches
Contextualization of CTG
Meconium Staining of the Amniotic Fluid
Pyrexia in Labor as a Risk Factor for Adverse Neonatal Outcome
Prolapse of the Umbilical Cord
Medicolegal Aspects of Fetal Monitoring
Behavioral Aspects of Fetal Monitoring.

Subject Areas: Gynaecology & obstetrics [MJT]