Intrapartum fetal assessment. A review

Some of the difficulty in assessing the clinical value of intrapartum fetal-heart-rate (FHR) monitoring stems from lack of uniformity in pattern interpretation and, therefore, in response to perceived FHR abnormalities. This article reviews the physiology and pathophysiology of FHR changes, stresses the new NICHD guidelines for unambiguously defining FHR patterns, emphasizes the avoidance of circumstances stressful to the fetus, and suggests appropriate treatment for the distressed fetus. The strong likelihood that such treatment will be successful in reversing abnormal FHR patterns, as well as the importance of preparing for expedient delivery should such treatment fail, are noted. Finally, some of the newer tools for judging the timing of perinatal brain injury are described.