Fetal Monitoring

Excerpt

Continuous fetal monitoring, or cardiotocography, is a method of tracking the fetal heart rate (FHR) along with the occurrence of uterine contractions. The relationship between these two variables is widely accepted to correlate with the oxygenation status of the fetus. This is intended to benefit the mother and fetus by providing obstetric clinicians with additional real-time information that they may use to determine if any intervention is necessary. In many areas of the United States, continuous intrapartum fetal monitoring has been used routinely for most women undergoing labor and delivery. However, the evidence basis for this is controversial as research has demonstrated that routine FHR monitoring is associated with increases in the rates of both operative vaginal deliveries and Cesarean sections without significantly improving most newborn or childhood outcomes.

Evidence is mixed on the effect of FHR monitoring on neonatal mortality, and a small reduction in the incidence of neonatal seizures has been observed when fetal monitoring is used. However, no benefit has been demonstrated from the use of fetal monitoring in most other perinatal outcomes, including Apgar scores, the incidence of neurologic injury, cerebral palsy, developmental delay, and NICU admission. Outside of the immediate intrapartum period, fetal monitoring may be used to evaluate for placental abruption, commonly when an obstetric patient presents following abdominal trauma. It may also be used to help differentiate true versus false labor. The ability to implement and interpret FHR monitoring is largely expected of obstetric care teams and is believed to serve a more important role in high-risk pregnancies and evaluation of fetal well-being outside of labor.