Continuous Monitoring of the Foetal Heart Rate and Uterine Contractions During Labour

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Abstract
Foetal welfare during labour may be monitored by continuous recording of the foetal heart rate (FHR) and uterine activity. The nomenclature relating to the FHR curve is outlined and the apparatus described. The FHR monitoring was based upon the foetal phonocardiogram (abdominal) or electrocardiogram (vaginal). 86 patients were monitored during labour, 34 of them because of an abnormal pregnancy or meconium‐stained amniotic fluid. In normal delivery (33 patients) early decelerations were observed during the second stage of labour in one‐half of the cases and bradycardia during the last minutes before delivery in one‐quarter. When the cord was around the neck (15 patients) variable decelerations occurred in one‐quarter and frequently deep early decelerations during the second stage of labour. In two of these cases the foetus developed hypoxia. Meconium‐stained amniotic fluid (10 patients), especially when combined with placental dysfunction, was a poor prognostic sign. One infant showing this sign died during delivery. The FHR curve showed tachycardia, minimal irregularity, and deep late decelerations. Another infant had severe brain damage and died later. Its FHR curve had shown increasing basal FHR and irregularity on the verge of the minimal. Lastly, in a case of deep late decelerations the infant was unaffected at birth. Within the total series FHR abnormalities were seen in 14 cases; 9 of the infants were unaffected, while 5 were depressed or dead. The FHR curve was normal in 72 cases; 71 of the infants were unaffected and only one depressed at birth. It is concluded that late decelerations may be a sign of hypoxia, especially when deep and combined with tachycardia. The most serious sign that the life of the foetus is in danger is cessation of the irregularity on the FHR curve.

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