Understanding cardiotocographic patterns associated with intrapartum fetal hypoxia and neurological injury

“If there are more focus on pattern recognition and pathophysiology it all becomes more evident.”

Obstetricians and midwives have been trained to focus on morphological appearances of fetal decelerations rather than to understand the underlying psychological mechanisms, how the fetus compensates and defends itself. In that way original interpretations of fetal heart patterns equated decelerations to fetal distress and mandated operative interventions. Since then consequently operative interventions are undertaken to rescue fetuses that display benign signs of fetal heart rate adaptations to event in labour. Appropriate interpretation of intrapartum FHR surveillance requires a deep understanding of normal fetal neurological behaviour, the behaviour of the fetal CVS (cerebral vascular insult) in response to different degrees of hypoxic-ischemic insults, the changes that indicate decompensation, and an acceptance that non-hypoxic fetal injuries are common and not necessarily detectable by current FHR monitoring tools or practice.

In this interesting paper by Austin Ugwumadu (PhD, FRCOG, Consultant and Senior Lecturer in Obstetrics and Gynaecology) the general characteristics of the fetal heart rate, the changes in the fetal heart rate pattern that may occur during labour and the patterns that suggest failure of the fetal compensatory mechanisms leading to injury are discussed.

 

Abstract – Ugwumadu A. 2013

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