Are we (mis)guided by current guidelines on intrapartum fetal heart rate monitoring?

Case for a more physiological approach to interpretation

In this interesting paper by Austin Ugwumadu  the general characteristics of the fetal heart rate, the changes in the fetal heart rate pattern that may occur during labour are discussed.


– An intact fetus with a normal CTG, who is exposed to hypoxia during labour will display a predictable set and sequence of FHR responses.

– With an abnormal CTG the clinician will be able to use the trends in fetal defensive/compensatory responses and separate the fetuses that are at risk of acidosis from the one that are not at risk.

– Current guidelines and training modules denies the obstetricians and midwives an understanding of how the fetus defends itself, compensates for intrapartum hypoxic ischemic insults and the ability to recognize the patterns that support loss of compensation.

– Maybe this is a cause of increased operative delivery of non-acidotic babies.

Abstract – Ugwumadu A. 2014

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