Intrapartum Fetal Monitoring Practice in the United Kingdom

Abstract

SummaryIn September 1978 a postal survey was made to establish the influence of continuous fetal heart rate monitoring on clinical practice in 264 Consultant Obstetric Units in the United Kingdom. Replies were received from 244 units (92·4 per cent) and only one of these did not possess any fetal heart monitors. The approximate percentage of patients monitored during labour in these units displayed a bimodal distribution with peaks at 20 to 30 and 80 to 90 per cent, reflecting a division of opinion about the need to monitor all or only ‘high risk’ patients. For each hospital the ratio of the numbers of patients delivered during 1977 to the number of monitors was calculated and the values ranged from 172 to 2708. In nearly 25 per cent of the hospitals it was not possible to monitor all high risk patients. Fetal blood pH estimation was used in conjunction with fetal heart rate measurement in 98 hospitals (40·2 per cent) but 38 (15·6 per cent) had a pH meter in or adjacent to the labour ward although this was not used for pH estimation. Midwives were taught to apply fetal scalp electrodes in half of the units but were taught to collect fetal blood samples in only two. It is suggested that there is a need (i) to improve the monitoring facilities in many units, (ii) to encourage midwives to become more involved in practical monitoring techniques and (iii) to develop improved methods for fetal pH determination during labour.

Changes in fetal monitoring practice in the UK: 1977–1984

“…Chamberlain & Gunn (1987) reported similar results, 31% of units delivering 2001-4000 patients per year, and 60% of those delivering >4000 women per year had access to fetal blood pH meters. Gillmer & Coombe (1979) commented that there was a 'need for improved methods of fetal pH determination to be developed'. This would still appear to be the case since 87% of responding consultants felt that this investigation would be used more often if a simpler technique were available.…”

Getting the balance right.

“…'2 Isotope scanning using gallium or technetium will show areas of active infection and may be used to monitor the response to treatment. [12][13][14] Prolonged local and systemic treatment is required, for ifit is too brief the disease tends to flare up again even when the ear has clinically healed. '5 Regular aural toilet is needed together with wicks impregnated with gentamicin and systemic antibiotics given intravenously.…”

Technical Aspects of Fetal and Intrauterine Pressure Monitoring

“…Despite the demonstrated effect of fetal pH measurement in reducing the incidence of false positive diagnosis of asphyxia in populations screened by electronic FHR mon itoring, thereby preventing an undue rise in the cesarean section rate (Beard, 1968;Beard et al, 1971b;Young et al, 1980), 60% of all obstetric units in the United Kingdom do not use the technique (Gillmer and Combe, 1979). This is probably due to the follow ing factors: (1) the cumbersome and time-consuming nature of the sampling process, (2) difficulties in obtaining consistent pH readings on the samples obtained, and (3) difficulties in the interpretation of the results, both technical and those resulting from a lack of understanding of the role of pH measurement in the diagnosis of fetal asphyxia.…”