Related Experiment Video
Updated: Feb 23, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
First do the experiment: Do computerised interpretation of cardiotocography and other widely used interventions
1Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, United Kingdom.
The introduction of continuous electronic fetal heart rate monitoring (EFM) in labour has coincided with a steady and remarkable fall in perinatal mortality. Whether this is cause or coincidence remains unclear because randomised trials have been underpowered. Attempts to improve the sensitivity and specificity of fetal compromise detection using fetal blood sampling and pH measurement, pulse oximetry, and fetal electrocardiogram analysis have failed to provide evidence of additional value in randomised trials. Recently, litigation to obtain compensation for obstetric and midwifery error, often reported to be failure to recognise abnormal EFM traces, has escalated. The hypothesis that computerised heart rate pattern recognition could reduce adverse outcomes was tested in a randomised controlled trial of 46,000 labours but showed no benefit. It seems that complicating risk factors such as fetal growth restriction, meconium liquor, pyrexia in labour, and excessive use of oxytocin, are more important than previously realised.
The introduction of continuous electronic fetal heart rate monitoring (EFM) in labour has coincided with a steady and remarkable fall in perinatal mortality. Whether this is cause or coincidence remains unclear because randomised trials have been underpowered. Attempts to improve the sensitivity and specificity of fetal compromise detection using fetal blood sampling and pH measurement, pulse oximetry, and fetal electrocardiogram analysis have failed to provide evidence of additional value in randomised trials. Recently, litigation to obtain compensation for obstetric and midwifery error, often reported to be failure to recognise abnormal EFM traces, has escalated. The hypothesis that computerised heart rate pattern recognition could reduce adverse outcomes was tested in a randomised controlled trial of 46,000 labours but showed no benefit. It seems that complicating risk factors such as fetal growth restriction, meconium liquor, pyrexia in labour, and excessive use of oxytocin, are more important than previously realised.
