The ability to diagnose fetal life through auscultation
of the fetal heart by applying the ear to the pregnant woman?s abdomen
was discovered in Europe during the early 19th century. Stethoscopic
auscultation of the fetal heart developed throughout the century, as its
potential to recognise fetal wellbeing was realised. Interest grew in
how to recognise changes in FHR that might foreshadow and prevent
intrapartum fetal death through obstetric intervention. Pinard?s version
of the fetal stethoscope appeared in 1876. Criteria for the normal FHR
set in the latter part of the 19th Century remained virtually unchanged
until the 1950?s. The same period saw interest and research into the
significance of meconium staining of the amniotic fluid as a means of
predicting fetal wellbeing. By the beginning of the 20th century,
auscultation of the fetal heart was an established practice in Europe.
Several factors have changed the significance of
intrapartum fetal monitoring. Only from the 1950s has caesarean section
become relatively safe with the advent of blood transfusion, antibiotics
and safe anaesthesia. Maternal mortality has become extremely rare and
interest has been able to focus increasingly on the welfare of the
Advances in the techniques of auscultation were limited
until the arrival of audiovisual technologies in the early 20th century.
These promised the possibility of a continuous form of monitoring. Early
electrocardiographic techniques were limited by their inability to
sufficiently eliminate maternal complexes. This problem was resolved by
the use of the fetal scalp electrode in 1960.
A considerable advance in technology with which to
detect the fetal heartbeat came in 1964 when the Doppler principle was
applied. In 1968, the first commercially available EFM applied Doppler?s
principle of a distinct change in frequency when a waveform is reflected
from a moving surface. The monitoring of fetal scalp blood acid-base was
developed in Germany in the 1960s and was introduced clinically as an
adjunct to continuous electronic fetal heart-rate monitoring to increase
The obstetric use of continuous electronic fetal heart
rate monitoring increased rapidly.8901,
Medical and socio-economic advances transformed maternal
birth outcomes in the 19th and 20th centuries. While the original aim of
intrapartum EFM was to prevent harm, it was introduced on to the labour
wards in the 1950s with the emphasis on improving fetal birth outcomes
by detecting fetal hypoxia, before it led to death or disability. Like
intermittent auscultation in the 19th century, continuous EFM was
introduced clinically before its effectiveness had been fully evaluated
One of the
priorities of intrapartum care is to enable women to make informed
choices regarding their care or treatment. To do so, they require access
to evidence-based information, professional advice and counselling to
help them in making their choices.
The aim of this web site is to provide a general
guide and it is not intended as a substitute for a consultation
with an appropriate specialist in respect of individual care and
David Viniker retired from active clinical practice in 2012.
In 1999, he setup this website - www.2womenshealth.com - to provide detailed
information many of his patients requested. The website attracts thousands of visitors every day from around the world.
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