Intrapartum fetal surveillance

Electronic fetal monitoring (EFM) is the recommended method of intrapartum fetal surveillance for high risk pregnancies. Despite the questions about its efficacy and controversy regarding increased rates of operative delivery associated with its use, continuous cardiotocography (CTG) remains the predominant method of intrapartum fetal monitoring. The CTG trace also forms a central piece of documentary evidence in medico-legal cases related to intrapartum hypoxia and birth asphyxia.Although CTG is sensitive in detecting abnormalities of fetal heart rate (FHR), its specificity for detection of fetal hypoxia remains low and therefore confirmatory tests such as fetal scalp blood sampling (FBS) or analysis of fetal electrocardiography (ECG) become necessary. Due to the rising costs of litigations related to birth asphyxia and increasing complexity of obstetric patient populations, it has become absolutely mandatory that all health professionals responsible for the care of women in labour are trained adequately in interpretation and documentation of CTG traces, as well as the guidelines for actions based on the assessment of the trace and overall clinical situation.Confidential enquiries have always pointed to factors such as inability to interpret traces, failure to incorporate the clinical situation, delay in taking appropriate action and poor team working as contributors to adverse perinatal outcomes. In this article we discuss three case scenarios of adverse maternal and perinatal outcomes due to failure to adhere to basic principles of fetal monitoring and recommended actions as per the national guidelines. The key learning points and risk management issues are also discussed.