Clinical use of the intrapartum-monitoring record

Current concepts in management of obstetric problems for pediatricians. I. Monitoring the high-risk fetus

Modern pediatric/neonatal practice demands an understanding of fetal monitoring. Biochemical techniques have given way to biophysical and ultrasonographic modalities in an attempt to improve both sensitivity and specificity. Simple techniques such as fetal movement counts show promise and are being investigated.

Second-stage fetal tachycardia and neonatal infection

Forty fetuses who had mild or marked tachycardia during the final 10 minutes of the second stage of labor were evaluated for neonatal infection. Prolonged sepsis/pneumonia occurred in 10 of the 40 infants (25%), three of eight (38%) with marked tachycardia, seven of 32 (22%) with mild tachycardia, and in only one of 167 control infants who had a normal second-stage fetal heart rate (0.6%). None of the 40 women with fetal tachycardia or the 167 control subjects had any intrapartum fever or other evidence of acute chorioamnionitis. Persistent fetal tachycardia during the second stage of labor defines a population at increased risk for subsequent neonatal sepsis/pneumonia. This population will require prolonged, expert neonatal care.

Reliability of ultrasound as compared to direct fetal electrocardiography for antepartum cardiotocography

Eighty-five pairs of simultaneously recorded external and internal cardiotocograms (CTGs) were coded and evaluated with a ten-point scoring system routinely used for the assessment of antepartum CTG. The highest consistency in interpretation between the external ultrasound and the internal fetal scalp CTG was found for basal heart rate followed by decelerations. Oscillatory amplitude and frequency were interpreted differently in 14 per cent of CTGs and accelerations in 16 per cent. When differences in interpretation arose, there was certainly no tendency for the external CTG to present an optimistic image of the fetal heart rate variables. With the exception of oscillatory amplitude all variables, including oscillatory frequency and the total CTG score, were more frequently underestimated than overestimated on external CTGs. When accelerations were present on only one recording, there was an 85 per cent chance for these to be absent on the external CTG. The study abolishes fears that the routine clinical assessment of antepartum CTGs of adequate technical quality provides overrated and more optimistic data than would by achieved by direct fetal scalp monitoring.