Fetal Heart Rhythm Research Articles

Fetal Bradyarrhythmias: A Comprehensive Update on Current Knowledge

Objective: This review aims to improve the accuracy and efficacy of ultrasound diagnosis of fetal bradyarrhythmias. Fetal arrhythmias represent 10% to 20% of referrals to specialized clinics for the evaluation of fetal heart rhythm abnormalities Mechanism: Various methods are available for assessing fetal heart rhythm through ultrasound and fetal echocardiography, which facilitate accurate diagnosis and help determine the optimal management strategies. Despite advancements in diagnostic techniques, the absence of studies with a substantial number of cases has resulted in significant variability in treatment approaches, influenced by local expertise and available resources. Findings in Brief: Fetal bradycardias can be transient or persistent conditions. Differentiating between them is critical for determining appropriate management. Second-trimester physiological transient bradycardia is characterized by temporary decelerations in fetal heart rate that resolve spontaneously to normal rhythm without requiring treatment or follow-up. In contrast, isolated or immune-mediated complete atrioventricular block may progress rapidly to hydrops, requiring close monitoring, medical intervention, and, in some cases, early delivery. Conclusion: In this review, we provide a comprehensive overview of all types of fetal bradycardias and the intrauterine management strategies used for their treatment.

Early-Stage Prototype Assessment of Cost-Effective Non-Intrusive Wearable Device for Instant Home Fetal Movement and Distress Detection: A Pilot Study.

Clinical fetal monitoring devices can only be operated by medical professionals and are overly costly, prone to detrimental false positives, and emit radiation. Thus, highly accurate, easily accessible, simplified, and cost-effective fetal monitoring devices have gained an enormous interest in obstetrics. In this study, a cost-effective and user-friendly wearable home fetal movement and distress detection device is developed and assessed for early-stage design progression by facilitating continuous, comfortable, and non-invasive monitoring of the fetus during the final trimester. The functionality of the developed prototype is mainly based on a microcontroller, a single accelerometer, and a specialized fetal phonocardiography (fPCG) acquisition board with a low-cost microphone. The developed system is capable of identifying fetal movement and monitors fetal heart rhythm owing to its considerable sensitivity. Further, the device includes a Global System for Mobile Communication (GSM)-based alert system for instant distress notifications to the mother, proxy, and emergency services. By incorporating digital signal processing, the system achieves zero false negatives in detecting fetal movements, which was validated against an open-source database. The acquired results clearly substantiated the efficacy of the fPCG acquisition board and alarm system, ensuring the prompt identification of fetal distress.

Home monitoring of fetal heart rhythm: Lived experiences of women with anti-SSA/Ro52 autoantibodies and their co-parents.

The aim of this study was to explore the parents' experiences of home monitoring of the fetal heart rhythm. Women with anti-SSA/Ro52 autoantibodies carry a 2%-3% risk of giving birth to a child with congenital heart block (CHB), following transplacental transfer and antibody-mediated inflammation in the fetal conduction system during 18th to 24th gestational week. Early detection and subsequent treatment have been reported to decrease morbidity and mortality. Therefore, home monitoring of the fetal heart rhythm by Doppler has been offered at our fetal cardiology center. This study was undertaken to explore the lived experience of the routine. Participants were recruited from a single fetal cardiology center. Consecutive sampling was used. The inclusion criteria were women with SSA/Ro52 antibodies who had undergone Doppler examinations within the last two and a half years at the hospital and had monitored the fetal heartbeat at home. A semi-structured questionnaire was created, and the participants were interviewed individually. The interviews were transcribed verbatim and analyzed according to qualitative content analysis. The overall theme was defined as "walking on thin ice," with six underlying categories: reality, different strategies, gain and loss, healthcare providers, underlying tension, and conducting the examinations again, all with a focus on how to handle the home monitoring during the risk period. Both the mother and the co-parent expressed confidence in their own abilities and that the monitoring provided them with the advantage of growing a bond with the expected child. However, all the participants described a feeling of underlying tension during the risk period. The results show that home monitoring is not experienced as complicated or a burden for the parents-to-be and should be considered a vital part of the chain of care for mothers at risk for giving birth to a child with CHB. However, explaining the teamwork between the different caregivers, for the patients involved, their areas of expertise, and how they collaborate with the patient continues to be a pedagogic challenge and should be developed further.

An intelligent quantification system for fetal heart rhythm assessment: A multicenter prospective study

BackgroundThe motion relationship and time intervals of the pulsed-wave Doppler (PWD) spectrum are essential for diagnosing fetal arrhythmia. However, few technologies currently are available to automatically calculate fetal cardiac time intervals (CTIs). ObjectiveThe purpose of this study was to develop a fetal heart rhythm intelligent quantification system (HR-IQS) for the automatic extraction of CTIs and establish the normal reference range for fetal CTIs. MethodsA total of 6498 PWD spectrums of 2630 fetuses over the junction between the left ventricular inflow and outflow tracts were recorded across 14 centers. E, A, and V waves were manually labeled by 3 experienced fetal cardiologists, with 17 CTIs extracted. Five-fold cross-validation was performed for training and testing of the deep learning model. Agreement between the manual and HR-IQS–based values was evaluated using the intraclass correlation coefficient and Spearman’s rank correlation coefficient. The Jarque-Bera test was applied to evaluate the normality of CTIs’ distributions, and the normal reference range of 17 CTIs was established with quantile regression. Arrhythmia subset was compared with the non-arrhythmia subset using the Mann-Whitney U test. ResultsSignificant positive correlation (P <.001) and moderate-to-excellent consistency (P <.001) between the manual and HR-IQS automated measurements of CTIs was found. The distribution of CTIs was non-normal (P <.001). The normal range (2.5th to 97.5th percentiles) was successfully established for the 17 CTIs. ConclusionsUsing our HR-IQS is feasible for the automated calculation of CTIs in practice and thus could provide a promising tool for the assessment of fetal rhythm and function.

Prospective Evaluation of High Titer Autoantibodies and Fetal Home Monitoring in the Detection of Atrioventricular Block Among Anti-SSA/Ro Pregnancies.

This prospective study of pregnant patients, Surveillance To Prevent AV Block Likely to Occur Quickly (STOP BLOQ), addresses the impact of anti-SSA/Ro titers and utility of ambulatory monitoring in the detection of fetal second-degree atrioventricular block (AVB). Women with anti-SSA/Ro autoantibodies by commercial testing were stratified into high and low anti-52-kD and/or 60-kD SSA/Ro titers applying at-risk thresholds defined by previous evaluation of AVB pregnancies. The high-titer group performed fetal heart rate and rhythm monitoring (FHRM) thrice daily and weekly/biweekly echocardiography from 17-26 weeks. Abnormal FHRM prompted urgent echocardiography to identify AVB. Anti-52-kD and/or 60-kD SSA/Ro met thresholds for monitoring in 261 of 413 participants (63%); for those, AVB frequency was 3.8%. No cases occurred with low titers. The incidence of AVB increased with higher levels, reaching 7.7% for those in the top quartile for anti-60-kD SSA/Ro, which increased to 27.3% in those with a previous child who had AVB. Based on levels from 15 participants with paired samples from both an AVB and a non-AVB pregnancy, healthy pregnancies were not explained by decreased titers. FHRM was considered abnormal in 45 of 30,920 recordings, 10 confirmed AVB by urgent echocardiogram, 7 being second-degree AVB, all <12 hours from normal FHRM and within another 0.75 to 4 hours to echocardiogram. The one participant with second/third-degree and two participants with third-degree AVB were diagnosed by urgent echocardiogram >17 to 72 hours from an FHRM. Surveillance echocardiograms detected no AVB when the preceding interval FHRM recordings were normal. High-titer antibodies are associated with an increased incidence of AVB. Anti-SSA/Ro titers remain stable over time and do not explain the discordant recurrence rates, suggesting that other factors are required. Fetal heart rate and rhythm (FHRM) with results confirmed by a pediatric cardiologist reliably detects conduction abnormalities, which may reduce the need for serial echocardiograms.

Prenatal testing - diagnostic possibilities in the 21st century with special emphasis on the diagnosis of genetic defects and heart defects

Introduction: Prenatal diagnosis is a branch of medicine that deals with the detection of possible genetic and developmental abnormalities at the fetal life stage. Due to the rapid development of technology in recent decades, diagnostic capabilities at the prenatal stage have also changed their face.&#x0D; Aim of the study: The aim of the study is to review the available scientific literature in order to systematize the current knowledge of prenatal diagnosis with particular emphasis on the diagnosis of genetic diseases and diagnosis of heart defects.&#x0D; Results: Prenatal diagnosis is divided into invasive and non-invasive diagnostics. Non-invasive diagnostics include ultrasound, maternal blood biochemical tests and NIPT tests. Invasive diagnostics include tests such as amniocentesis and chorionic villus biopsy. Prenatal tests provide information on the risk of genetic diseases such as trisomy 21, 13 and 18 chromosome. In addition, serious structural heart defects such as tetralogy of Fallot are likely to be detected during prenatal diagnosis. Prenatal testing can also detect fetal heart rhythm abnormalities, which makes it possible to start treatment at an early stage. Modern ultrasound technology also allows 3D imaging, which can also provide valuable diagnostic information.&#x0D; Summary: Prenatal diagnosis is a highly developed field of medicine that combines knowledge from various specialties. Thanks to prenatal diagnosis, it is possible to detect various abnormalities at an early stage of fetal life, which enables early treatment.

CO60 Maternal Mental Health Disorders May Increase Odds of Adverse Intrauterine and Birth Outcomes

Congenital heart defects (CHD) affect approximately 40,000 births per year in the United States. Various combinations of genetic and secondary contributors have been proposed, and researchers continue to explore additional predictors of CHD causation. This study aimed to determine the relationship between maternal mental health disorder (MMHD) history and the incidence of abnormalities in fetal heart rate or rhythm as well as the incidence of stillbirth.

Policies Affecting Pregnant Women with Substance Use Disorder

Policies Affecting Pregnant Women with Substance Use Disorder

Potentially acute misoprostol toxicity during third-trimester pregnancy: a case report

Background: The International Federation of Gynecology and Obstetrics (FIGO) recommends the dosage of misoprostol for pregnancy termination in &gt;28 weeks is 25 mcg to 100 mcg per-vaginal or sublingual or buccal, every 6 hours, and the maximum dose is 6 mg. Acute misoprostol toxicity is rarely reported, including in the case of pregnant women. This study aims to discuss the effect of potentially acute misoprostol toxicity in pregnant women and the fetus. Case Presentation: A 17 years-old woman, G1, 32 weeks, presented with singleton intrauterine fetal death. The patient previously consumed 14 tabs of oral misoprostol and 4 tabs of misoprostol intravaginally. Her vital signs were within a normal level, his 4x/10'/40", and her fetal heart rhythm was negative. From vaginal touché found complete dilation. The patient led to bear down and born baby boy, demise fetal, 1965-gram, 43 cm, no maceration and placenta born completely. After delivery, the mother was in good condition. Misoprostol is a synthetic analog of prostaglandin E1, which can be used for uterotonics and cervical ripening. In pregnant women, misoprostol toxicity can induce hypertonic uterine contractions, leading to fetal distress and death, rhabdomyolysis, hyperthermia, respiratory alkalosis, hypoxemia, and metabolic acidosis. One article reported maternal death due to upper gastrointestinal bleeding and multiorgan failure. We analyze that intrauterine fetal death may happen because of excessive misoprostol that induces hypertonic uterine contraction, causing fetal distress and leading to fetal demise. Conclusion: Excessive consumption of misoprostol or potentially acute misoprostol during the third-semester pregnancy can lead to harmful effects for both mother and fetus.

Cesarean scar pregnancy: A clinical case report

Background: Among the different forms of ectopic pregnancy, cesarean scar pregnancy is one of the most uncommon with an estimated incidence of 1/1800 pregnancies. A major risk of massive hemorrhage, it requires active management as soon as it is diagnosed because it can affect the functional prognosis of the patient (hysterectomy) but can also be life-threatening. Different surgical techniques are generally proposed in first intention to patients who no longer wish to have children, who are hemodynamically unstable and/or in case of failure of medical treatment. Case presentation: We hereby report the case of a young 19-year-old patient with no particular medical history, gravida 2 para 1 with a live child born after a cesarean section for fetal heart rhythm abnormalities during labor 5 months earlier and who presented to the emergency room of our structure for the management of a cesarean pregnancy scar diagnosed at 6 weeks of amenorrhea. She was successfully managed with an intramuscular injection of methotrexate. The follow-up was uneventful. Conclusion: The implantation of a pregnancy on a cesarean section scar is becoming more and more frequent. With consequences that can be dramatic, ranging from hysterectomy to life-threatening hemorrhage, clinicians must be familiar with this pathological entity and be prepared for its management. The latter must be rapid and allow, if necessary, the preservation of the patient's fertility. In this sense, conservative medical treatment with methotrexate injections should be proposed as a first-line treatment in the absence of contraindication.

Prenatally diagnosed fetal heart rhythm abnormalities—incidence, diagnosis and outcome

Backrounds: Fetal arrhythmias represent a significant cause of fetal morbidity and mortality and occur in approximately 1–3% of pregnancies. The unknown fetal arrhythmias are the cause of intrauterine fetal demise in as many as 3–10% of cases, as well as the cause of unexplained fetal hydrops or premature births. Methods: A fetal echocardiography test makes it possible to notice structural heart defects at very early stages of pregnancy. The ultrasound heart rate monitoring also involves the use of specific Doppler methods. Heart rhythm disorders may occur in the form of tachycardia (sinus tachycardia (ST), supraventricular tachycardia (SVT) and atrial flutter (AF)) or in the form of bradycardia (sinus bradycardia (SB), atrial bigeminy (AB) and complete AV block). The most frequently diagnosed fetal heart rhythm disorders are isolated extrasystoles with no clinical significance. Results: In this study, we have examined 7863 fetuses (182 were multiple gestations). Out of the total number of examined patients, 572 fetuses (7.23%) had pathological heart features, while 127 (1.61%) had some form of rhythm disorder. Conclusions: The ability to recognize the heart rhythm disorder and commence the treatment in a timely manner increases the treatment success rate.

Novel approaches to the surveillance and management of fetuses at risk for anti-Ro/SSA mediated atrioventricular block

Approximately one percent of pregnant women will produce anti-Sjogren's syndrome-related antigen A (anti-Ro/SSA) antibodies. Of these pregnancies, one to three percent will have a fetus that develops atrioventricular (AV) block. Earlier stages of AV block (1° or 2°) may respond to anti-inflammatory treatment, but complete (3°) AV block, which can occur within 24 hours of a normal fetal rhythm, is likely irreversible and carries substantial risk for significant morbidity and for mortality. Emerging data has shown that ambulatory fetal heart rhythm monitoring can detect the transition period from normal rhythm to 2° AV block, the time during which treatment with IVIG and dexamethasone can potentially restore normal sinus rhythm. Weekly or biweekly fetal echocardiograms occur too infrequently to detect this transition period but may still be useful in diagnosing extranodal anti-Ro antibody mediated cardiac disease. In this review, we evaluate the most innovative methods for surveillance and treatment of this disease.

Multiparametric Investigation of Dynamics in Fetal Heart Rate Signals.

In the field of electronic fetal health monitoring, computerized analysis of fetal heart rate (FHR) signals has emerged as a valid decision-support tool in the assessment of fetal wellbeing. Despite the availability of several approaches to analyze the variability of FHR signals (namely the FHRV), there are still shadows hindering a comprehensive understanding of how linear and nonlinear dynamics are involved in the control of the fetal heart rhythm. In this study, we propose a straightforward processing and modeling route for a deeper understanding of the relationships between the characteristics of the FHR signal. A multiparametric modeling and investigation of the factors influencing the FHR accelerations, chosen as major indicator of fetal wellbeing, is carried out by means of linear and nonlinear techniques, blockwise dimension reduction, and artificial neural networks. The obtained results show that linear features are more influential compared to nonlinear ones in the modeling of HRV in healthy fetuses. In addition, the results suggest that the investigation of nonlinear dynamics and the use of predictive tools in the field of FHRV should be undertaken carefully and limited to defined pregnancy periods and FHR mean values to provide interpretable and reliable information to clinicians and researchers.

Relationship between Twin-to-Twin Selective Intrauterine Growth Restriction with sFas/sFasL Level of Umbilical Cord Blood Using Doppler Ultrasound Fetal Heart Rhythm Detection Algorithm

The study focused on the application value of ultrasound Doppler fetal heart rate detection algorithm based on short-time Fourier transform (STFT) in the diagnosis of twin-to-twin selective intrauterine growth restriction (sIUGR) and the correlation between twin-to-twin sIUGR and sFas/sFasL levels of umbilical cord blood. The normalized method was introduced into the STFT algorithm to optimize it to detect the fetal instantaneous heart rate. 82 pregnant women with twin pregnancies were selected as the research subjects and they were divided into the restricted group (41 cases) and the control group (41 cases) according to whether the fetus had selective growth restriction. The two groups were compared for the differences in the fetal mortality, complication rate, and sFas/sFasL expression levels. The results showed that the STFT-based ultrasonic Doppler fetal heart rate detection algorithm could ensure the quality of the fetal heart rate signal and had high resolution at the 200–400 Hz characteristic frequency band and that the accuracy in distinguishing S1 and S2 was 5.8% higher than that of the traditional autocorrelation algorithm. The proportion of abnormal fetal heart rate in the restricted group was significantly higher than that in the control group ( P &lt; 0.05 ), birth weight was significantly lower than that in the control group ( P &lt; 0.05 ), and fetal mortality was significantly higher than that in the control group ( P &lt; 0.05 ). There was no statistical difference in the incidence of complications between the two groups ( P &gt; 0.05 ). In restricted group, the content of sFas in cord blood was (3326.54 ± 317.42) pg/mL and that in the control group was (2003.29 ± 196.45) pg/mL. The content of sFas in cord blood of the restricted group was significantly higher than that of the control group ( P &lt; 0.01 ). In the restricted group, the content of sFasL in cord blood was (382.52 ± 36.17) pg/mL, and that in the control group was (180.84 ± 16.20) pg/mL. The content of sFasL in cord blood of the restricted group was significantly higher than that of the control group ( P &lt; 0.001 ). It was concluded that the STFT-based ultrasound Doppler fetal heart rate monitoring is beneficial to early diagnosis and timely intervention of twin-to-twin sIUGR.

Quantitative evaluation of fetal ventricular function by speckle tracking echocardiography.

The study included 59 patients with normal fetal heart structure, blood flow, and heart rhythm (fetal abnormality-negative group) and 50 patients with abnormal fetal heart structure, blood flow, and/or heart rhythm (fetal abnormality-positive group). Automated Cardiac Motion Quantification (aCMQ) was performed in both groups to obtain left and right ventricular endocardial global longitudinal strain (GLSendo), mid-myocardial global longitudinal strain (GLSmid), and epicardial global longitudinal strain (GLSepi). Parameters between the two groups were compared and correlation analyses performed. A deformation analysis was performed by two trained observers, and reproducibility was assessed. The fetal left ventricular and right ventricular global longitudinal strain (LV-GLS and RV-GLS, respectively) decreased in a gradient from the endocardium to the epicardium. LV-GLS and RV-GLS of all myocardial layers were lower in the fetal abnormality-positive than -negative group (all P<0.05). Correlation analysis showed that neither LV-GLS nor RV-GLS was significantly correlated with gestational age in the fetal abnormality-negative group (all P>0.05), whereas left ventricular GLSendo, GLSmid, and GLSepi were negatively correlated with gestational age in the fetal abnormality-positive group (r=-.39 to -.44, all P<0.05). Repeatability testing showed that the inter-observer and intra-observer intra-class correlation coefficients for LV-GLS and RV-GLS in each myocardial layer were>.75 (all P<0.001). As a new speckle tracking echocardiography tool, aCMQ has feasibility and repeatability in evaluating myocardial deformation of the fetal ventricle. This technique might provide helpful information on ventricular myocardial deformation in fetal hearts with abnormal structure or rhythm for clinical guidance in pregnancy.

Treatment of Fetal Arrhythmias.

Fetal arrhythmias are mostly benign and transient. However, some of them are associated with structural defects or can cause heart failure, fetal hydrops, and can lead to intrauterine death. The analysis of fetal heart rhythm is based on ultrasound (M-mode and Doppler echocardiography). Irregular rhythm due to atrial ectopic beats is the most common type of fetal arrhythmia and is generally benign. Tachyarrhythmias are diagnosed when the fetal heart rate is persistently above 180 beats per minute (bpm). The most common fetal tachyarrhythmias are paroxysmal supraventricular tachycardia and atrial flutter. Most fetal tachycardias can be terminated or controlled by transplacental or direct administration of anti-arrhythmic drugs. Fetal bradycardia is diagnosed when the fetal heart rate is slower than 110 bpm. Persistent bradycardia outside labor or in the absence of placental pathology is mostly due to atrioventricular (AV) block. Approximately half of fetal heart blocks are in cases with structural heart defects, and AV block in cases with structurally normal heart is often caused by maternal anti-Ro/SSA antibodies. The efficacy of prenatal treatment for fetal AV block is limited. Our review aims to provide a practical guide for the diagnosis and management of common fetal arrythmias, from the joint perspective of the fetal medicine specialist and the cardiologist.

Joint symbolic dynamics identifies differences in the maternal-fetal cardiac coupling between nonlaboring and laboring women

There is a growing interest in investigating maternal-fetal cardiac coupling (MFCC) to identify the physiological processes involved in fetal development and well-being during pregnancy. No evidence of MFCC has been reported during active labor, a critical stage at the end of pregnancy for the mother-child binomial. Therefore, this exploratory study compares the short-term MFCC between nonlaboring and laboring women by applying nonlinear joint symbolic dynamics (JSD).Forty-four pairs of maternal-fetal RR interbeat intervals series were longitudinally analyzed during the third trimester of pregnancy (TT, 36.5 ±1.7 weeks of gestation) and later at active parturition at term (P, 39.4 ±1.2 weeks gestation), corresponding to low-risk pregnant women (N=22). For each pair of maternal-fetal interbeat intervals series at TT and P, a word distribution density matrix was calculated to assess general and partial coupling behavior.The JSD approach revealed changes in the MFCC, permitting the identification of differences between the TT and P conditions (p < 0.0001). The general indices revealed a significant increment of the short-term MFCC at P and the probability of similar (alike) and opposite cardiovascular fluctuations. Partial indices also confirmed coupling changes between both conditions.Our results show short-term MFCC increments at P, probably influenced by the effects of the intense uterine contractile activity and other interactions on both fetal and maternal heart rhythm fluctuations. We conjecture that JSD analysis of maternal and fetal heart rate during labor may be appropriate for monitoring physiological mechanisms involved in the mother-child binomial.

Evaluation of the fetal heart rhythm in clinical practice – review

Evaluation of the fetal heart rhythm in clinical practice – review

Successful treatment of neonatal atrial flutter by synchronized cardioversion: case report and literature review

BackgroundAtrial flutter (AFL) is a supraventricular tachyarrhythmia. In the ECG tracing, it is marked by a fast, irregular atrial activity of 280–500 beats per minute. AFL is known to be a rare and also life-threatening rhythm disorder both at the fetus and neonatal period. AFL may result in circulatory failure, and in a more severe form, it may lead to a non-immune fetal hydrops. However, with early prenatal diagnosis and proper treatment, the majority of AFL cases show a good prognosis.Case presentationWe report a case of a neonate who was born at 34 weeks of gestational age by C-section because of risk for birth asphyxia, based on abnormal CTG tracing, which had no characteristic rhythms for fetal decelerations. A third day his heart rate was 220/bpm. ECG has shown supraventricular tachycardia with narrow QRS. The administration of adenosine resulted in the obvious appearance of “sawtooth wave” typical for AFL. Arrhythmia was resistant to the therapy of amiodaron. Then cardioversion was performed and the rhythm converted to normal.ConclusionsAs neonatal AFL might be resistant to conventional pharmacotherapy, one needs to remember about the possibility of electrical cardioversion in the pediatric cardiology referral center. Moreover, CTG monitoring is of limited use because it does not record fetal heart rhythms > 200/min and echocardiography at the reference center is practically the only method to monitor the condition of the fetus with abnormal rapid heart rhythm.

Solving the Obstetrical Paradox: The FETAL Technique-A Step toward Noninvasive Evaluation of Fetal pH.

Every year, about 85 percent of the approximately 5 million births in North America are evaluated with the electronic fetal monitoring (EFM). Clinicians use the EFM as a proxy to assess fetal oxygenation status, fetal well-being, and potential compromise. Despite the widespread use of this technology, neonatal hypoxia and acidosis continue to make up a high proportion of neonatal morbidity at term. Indeed, though the fetal heart rhythm is inextricably linked to fetal acid-base status, EFM has not been shown to reliably predict neonatal pH status nor has it reduced adverse maternal or neonatal outcomes. As a consequence, the high false-positive rate of EFM for predicting adverse neonatal outcomes has led to an increase in the rate of operative vaginal and cesarean delivery, with elevated rates of associated maternal and neonatal morbidity. This fact invariably leads to a paradox we have henceforth defined as the “obstetrical paradox.” Herein, we explore the potential solutions to this paradox and introduce a novel noninvasive technique to assess fetal acid-base status in utero known as the “FETAL technique” (Fourier Evaluation of Tracings and Acidosis in Labour). The FETAL technique, currently under investigation, applies the discrete Fourier transformation to EFM tracings to determine the spectral frequency distribution of the fetal heart rate. These specific frequency distributions correlate with specific umbilical pH values and may provide the missing link between fetal heat rate patterns and acid-base status at birth. As we work toward realizing the full potential benefits of EFM, finding the best assessment strategies to evaluate fetal pH in real time remains a key goal in obstetrics.