Electronic fetal heart rate monitoring: help or hindrance?

Abstract

Cerebral Palsy is a non-progressive disease of the developing fetal brain thought to arise from hypoxic or infective insults in the antepartum and intrapartum periods. Electronic fetal monitoring in the form of the cardiotocography (CTG) was designed to assess fetal wellbeing and reduce the incidence of cerebral palsy: it has not. The widespread use of CTG in low risk women has increased the rate of intervention in the form of instrumental delivery and caesarean section. Severe abnormalities of the CTG require action either by fetal blood sampling or expedition of delivery; yet some of these babies with ‘pathological’ CTGs will have no evidence of fetal hypoxia (i.e. a normal cord pH). In addition, some pathological traces are not recognized or acted upon appropriately. This article discusses the case for and against electronic fetal monitoring in pregnant women.