Reframing antepartum and intrapartum surveillance

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Fetal Physiology

Background:

• Electronic fetal monitoring (EFM) initially aimed to reduce stillbirths, a goal largely achieved.
• Subsequent efforts to reduce neurologic impairment, including cerebral palsy, using EFM have yielded contradictory data over 50 years.
• The cesarean delivery rate has increased sixfold, associated with higher complications and costs, despite EFM's limitations in detecting fetal distress.

Purpose of the Study:

• To review the evolution of antenatal and intrapartum fetal monitoring techniques.
• To introduce a novel, re-engineered approach to intrapartum fetal monitoring called the Fetal Reserve Index (FRI).
• To demonstrate the potential of the FRI to improve early identification of fetal risk and guide interventions.

Main Methods:

• Review of multiple generations of antenatal testing schemes.
• Development and application of the Fetal Reserve Index (FRI) for intrapartum monitoring.
• The FRI quantifies fetal heart rate, variability, accelerations, and decelerations, incorporating uterine activity and maternal/fetal risk factors.
• Initial version (1.0) weights all parameters equally.

Main Results:

• The FRI enables improved and earlier identification of fetal risk within the pathophysiology.
• This facilitates less abrupt and dramatic interventions compared to traditional methods.
• Early postpartum period identified as a phase with commonly unrecognized risks.

Conclusions:

• The Fetal Reserve Index (FRI) represents a significant advancement over subjective EFM category systems.
• The FRI offers a more objective and quantifiable approach to intrapartum fetal surveillance.
• Envisioning a continuum of care from antepartum through postpartum assessment for optimal perinatal outcomes.