Intrapartum fetal monitoring: Maximizing benefits and minimizing risk

February 1, 2010

Electronic feta l heart rate (FHR) monitoring was introduced in the late 1960s with the hope of preventing intrapartum fetal brain injury and cerebral palsy (CP). However, it is now clear that this hope was unrealistic for at least 2 reasons. First, the false-positive rate of intrapartum FHR monitoring for predicting CP exceeds 99%. Except in the most extreme cases, intrapartum FHR monitoring has never been capable of reliably predicting CP.

Key Points

Electronic fetal heart rate (FHR) monitoring was introduced in the late 1960s with the hope of preventing intrapartum fetal brain injury and cerebral palsy (CP).1 However, it is now clear that this hope was unrealistic for at least 2 reasons. First, the false-positive rate of intrapartum FHR monitoring for predicting CP exceeds 99%.2 Except in the most extreme cases, intrapartum FHR monitoring has never been capable of reliably predicting CP. Second, most cases of CP originate outside the intrapartum period and therefore cannot be prevented by any form of intrapartum monitoring or intervention.3

A growing body of evidence indicates that standardization of intrapartum management can reduce adverse outcomes and professional liability claims.4,5 However, for many years, standardization of FHR monitoring was impeded by lack of consensus. Without evidence-based standardization, clinicians were left without clear guidance and often found themselves facing unfounded accusations of mismanagement.

Standardized definitions

Standardized interpretation

Scientific evidence and consensus in the literature can distill intrapartum FHR interpretation into 3 central concepts.