Journal
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Volume 121, Issue 9, Pages 1063-1070Publisher
WILEY-BLACKWELL
DOI: 10.1111/1471-0528.12900
Keywords
CTG practice algorithm; deceleration; fetal cardiovascular physiology; intrapartum fetal heart rate monitoring
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Original interpretations of fetal heart rate (FHR) patterns equated FHR decelerations with 'fetal distress', requiring expeditious delivery. This simplistic interpretation is still implied in our clinical guidelines despite 40 years of increasing understanding of the behaviour and regulation of the fetal cardiovascular system during labour. The physiological basis of FHR responses and adaptations to oxygen deprivation is de-emphasised, whilst generations of obstetricians and midwives are trained to focus on, and classify, the morphological appearances of decelerations into descriptive categories, with no attempt to understand how the fetus defends itself and compensates for intrapartum hypoxic ischaemic insults, or the patterns that suggest progressive loss of compensation. Consequently, there is a lack of confidence, marked variation in FHR interpretation, defensive practices, unnecessary operative interventions, and a failure to recognise abnormal FHR patterns, resulting in adverse outcomes and expensive litigation.
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