Approaches to Preventing Intrapartum Fetal Injury
Electronic fetal monitoring (EFM) was introduced into obstetric practice in 1970 as a test to identify early deterioration of fetal acid-base balance in the expectation that prompt intervention (“rescue”) would reduce neonatal morbidity and mortality. Clinical trials using a variety of visual or com...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.915344/full |
| _version_ | 1811266246578012160 |
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| author | Barry S. Schifrin Brian J. Koos Brian J. Koos Wayne R. Cohen Mohamed Soliman Mohamed Soliman |
| author_facet | Barry S. Schifrin Brian J. Koos Brian J. Koos Wayne R. Cohen Mohamed Soliman Mohamed Soliman |
| author_sort | Barry S. Schifrin |
| collection | DOAJ |
| description | Electronic fetal monitoring (EFM) was introduced into obstetric practice in 1970 as a test to identify early deterioration of fetal acid-base balance in the expectation that prompt intervention (“rescue”) would reduce neonatal morbidity and mortality. Clinical trials using a variety of visual or computer-based classifications and algorithms for intervention have failed repeatedly to demonstrate improved immediate or long-term outcomes with this technique, which has, however, contributed to an increased rate of operative deliveries (deemed “unnecessary”). In this review, we discuss the limitations of current classifications of FHR patterns and management guidelines based on them. We argue that these clinical and computer-based formulations pay too much attention to the detection of systemic fetal acidosis/hypoxia and too little attention not only to the pathophysiology of FHR patterns but to the provenance of fetal neurological injury and to the relationship of intrapartum injury to the condition of the newborn. Although they do not reliably predict fetal acidosis, FHR patterns, properly interpreted in the context of the clinical circumstances, do reliably identify fetal neurological integrity (behavior) and are a biomarker of fetal neurological injury (separate from asphyxia). They provide insight into the mechanisms and trajectory (evolution) of any hypoxic or ischemic threat to the fetus and have particular promise in signaling preventive measures (1) to enhance the outcome, (2) to reduce the frequency of “abnormal” FHR patterns that require urgent intervention, and (3) to inform the decision to provide neuroprotection to the newborn. |
| first_indexed | 2024-04-12T20:38:37Z |
| format | Article |
| id | doaj.art-b8b8ab6da7184edebc49b4169979b884 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-12T20:38:37Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-b8b8ab6da7184edebc49b4169979b8842022-12-22T03:17:30ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-09-011010.3389/fped.2022.915344915344Approaches to Preventing Intrapartum Fetal InjuryBarry S. Schifrin0Brian J. Koos1Brian J. Koos2Wayne R. Cohen3Mohamed Soliman4Mohamed Soliman5Department of Obstetrics and Gynecology, Western University of Health Sciences, Pomona, CA, United StatesDepartment of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United StatesDepartment of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, United StatesDepartment of Obstetrics and Gynecology, University of Arizona College of Medicine, Tucson, AZ, United StatesDepartment of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United StatesDepartment of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, United StatesElectronic fetal monitoring (EFM) was introduced into obstetric practice in 1970 as a test to identify early deterioration of fetal acid-base balance in the expectation that prompt intervention (“rescue”) would reduce neonatal morbidity and mortality. Clinical trials using a variety of visual or computer-based classifications and algorithms for intervention have failed repeatedly to demonstrate improved immediate or long-term outcomes with this technique, which has, however, contributed to an increased rate of operative deliveries (deemed “unnecessary”). In this review, we discuss the limitations of current classifications of FHR patterns and management guidelines based on them. We argue that these clinical and computer-based formulations pay too much attention to the detection of systemic fetal acidosis/hypoxia and too little attention not only to the pathophysiology of FHR patterns but to the provenance of fetal neurological injury and to the relationship of intrapartum injury to the condition of the newborn. Although they do not reliably predict fetal acidosis, FHR patterns, properly interpreted in the context of the clinical circumstances, do reliably identify fetal neurological integrity (behavior) and are a biomarker of fetal neurological injury (separate from asphyxia). They provide insight into the mechanisms and trajectory (evolution) of any hypoxic or ischemic threat to the fetus and have particular promise in signaling preventive measures (1) to enhance the outcome, (2) to reduce the frequency of “abnormal” FHR patterns that require urgent intervention, and (3) to inform the decision to provide neuroprotection to the newborn.https://www.frontiersin.org/articles/10.3389/fped.2022.915344/fullcardiotocographyexcessive uterine activityfetal compensatory responsesfetal monitoringfetal neurological injuryfetal hypoxia-ischemia |
| spellingShingle | Barry S. Schifrin Brian J. Koos Brian J. Koos Wayne R. Cohen Mohamed Soliman Mohamed Soliman Approaches to Preventing Intrapartum Fetal Injury Frontiers in Pediatrics cardiotocography excessive uterine activity fetal compensatory responses fetal monitoring fetal neurological injury fetal hypoxia-ischemia |
| title | Approaches to Preventing Intrapartum Fetal Injury |
| title_full | Approaches to Preventing Intrapartum Fetal Injury |
| title_fullStr | Approaches to Preventing Intrapartum Fetal Injury |
| title_full_unstemmed | Approaches to Preventing Intrapartum Fetal Injury |
| title_short | Approaches to Preventing Intrapartum Fetal Injury |
| title_sort | approaches to preventing intrapartum fetal injury |
| topic | cardiotocography excessive uterine activity fetal compensatory responses fetal monitoring fetal neurological injury fetal hypoxia-ischemia |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.915344/full |
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