Fetal monitoring and anaesthesia for fetal distress

Abstract

Fetal monitoring Should all parturients have continuous electronic fetal heart rate (FHR) monitoring during labour? Large prospective, randomized studies suggest that there is little or no benefit to the universal use of continuous, electronic FHR monitoring during labour. 1-9 Further, some studies suggest that electronic FHR monitoring results in an increased incidence of Caesarean section. 1,3,4,7 Guidelines for Perinatal Care, third edition, l0 includes the following statement regarding FHR monitoring for high-risk patients: has been shown that with a 1:1 nurse/patient ratio, intermittent auscultation at intervals of 15 minutes during the active phase of the first stage of labor and 5 minutes during the second stage is equivalent to continuous electronic fetal heart rate It is unlikely, however, that many obstetricians in the United States will abandon the use of universal, continuous electronic FHR monitoring. Few labour and delivery units in the United States can consistently satisfy the nursing standards required for rigorous, intermittent auscultation of the FHR. Further, the fear of litigation prompts many obstetricians to use electronic FHR monitoring in their patients. Most of the aforementioned studies were performed in hospitals with infrequent utilization of epidural anaesthesia during labour. Thus, these studies may not be applicable for women receiving regional anaesthesia during labour. Neither the American Society of Anesthesiologists (ASA) nor the American College of Obstetricians and Gynecologists (ACOG) has issued specific guidelines regarding FHR monitoring in patients receiving regional anaesthesia. The ASA It has stated: Regional anesthesia for labor and/or vaginal delivery requires that the parturient's vital signs and the fetal heart rate be monitored and documented by a qualified individual. Additional monitoring appropriate to the clinical condition of the parturient and the fetus should be employed when indicated. The ACOG 12 has stated: When maternal hemodynamics are changing, such as with maternal hypotension from conduction anesthesia or maternal hemorrhage, increased fetal surveillance may be indicated. (Of course, one cannot predict which patients will experience hypotension during regional anaesthesia.) I prefer that my patients have continuous electronic FHR monitoring before, during, and after induction of epidural anaesthesia during labour.