Generational Leaps in Intrapartum Fetal Surveillance

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Medical Technology

Background:

• Electronic fetal monitoring (EFM) has been a standard for intrapartum fetal surveillance for over 50 years.
• Despite extensive research, its effectiveness in reducing perinatal morbidity and mortality remains debated.
• This review explores historical EFM advancements and future surveillance strategies.

Purpose of the Study:

• To chronologically review the evolution of electronic fetal monitoring (EFM) techniques.
• To assess the efficacy of ancillary methods and automated systems in improving fetal surveillance.
• To identify future directions for intelligent intrapartum fetal surveillance systems.

Main Methods:

• Chronological review of EFM developments, including fetal ECG analysis, automated FHR analysis, and AI.
• Analysis of the transition from visual interpretation to intelligent systems.
• Evaluation of automated monitoring platform performance.

Main Results:

• Ancillary methods and automated systems have shown limited success in improving EFM accuracy.
• Fetal ECG analysis has shown some benefit when combined with visual interpretation.
• Novel approaches like the Fetal Reserve Index (FRI) demonstrate potential by integrating clinical risk factors.

Conclusions:

• Visual interpretation of fetal heart rate (FHR) patterns has persistent limitations.
• Future systems require comprehensive risk assessment combining maternal, fetal, and obstetric factors.
• Integrating AI with contextualized metrics like FRI offers the most promising path for improved outcomes.