Intrapartum Fetal Surveillance (IFS)
Intermittent auscultation of the fetal heart rate (FHR) and continuous electronic fetal heart rate monitoring (EFM) are the most popular methods of intrapartum fetal surveillance.
EFM has become popular because of the possible on-line documentation, easy application of the equipment, accuracy of picking up the fetal heart rate signal and because of the additional information obtained about the FHR and uterine contractions.
ADMISSION TEST (AT)
Fetal morbidity and mortality occurs as a consequence of labor even in those categorized as low risk. A better way to screen pts admitted in labor is to assess the ability of the fetus to withstand the functional stress of uterine contractions of early labor. A short recording of the FHR immediately after admission - the admission test (AT) - might select these fetuses with hypoxia present on admission or those who are likely to become hypoxic in the next few hours of labor.
The following points about intrapartum fetal surveillance need to be noted:
- The baby's heart rate during labor correlates poorly with measures of the baby's condition at birth.
- Measures of the baby's condition at birth correlate poorly with long-term outcomes.
- Comparisons of EFM and intermittent auscultation show that EFM offers no long-term benefits in either low or high-risk pregnancies (although it may have short-term benefits especially when oxytocin is used).
- Comparisons of EFM and intermittent auscultation show that EFM increases the likelihood of cesarean and vaginal instrumental delivery, infection and cerebral paisy in premature babies.
The routine use of technology does not appeal to the consumer or to the scientific world. Selective EFM with an AT followed by intermittent electronic monitoring every 2-3 hours and auscultation in between may be adequate and appropriate in low risk pregnancies. High risk pregnancies would benefit by continuous EFM.