Intrapartum fetal surveillance

Abstract

Labour is a time of fetal stress and whilst the vast majority of babies emerge from labour healthy and intact a small minority will be damaged in some way. When hypoxia in labour is prolonged and/or severe babies are at risk of being born with neurological damage and disability or even of death. In the UK 500 babies each year die during or shortly after labour; a large number of these deaths occur in babies that enter labour apparently healthy. These cases represent a tragedy for the individual families concerned. Uterine contractions may cause fetal hypoxia by the action of repeated cord compression or a reduction in retro placental perfusion. Profound fetal hypoxia may also occur with a sudden catastrophic intrapartum event such as cord prolapse, abruption or scar dehiscence. The aim of fetal surveillance in labour is to identify hypoxia and allow intervention to prevent the sequelae of asphyxia. Despite the extensive uptake of intrapartum fetal surveillance in the last 20–30 years, particularly in the form of CTG monitoring, the hope for impact on intrapartum asphyxia has not occurred. This article aims to outline the principles of intrapartum fetal surveillance and recent changes in the field; highlight areas of shortfall and suggest future directions that could potentially reduce avoidable intrapartum morbidity and mortality.