History Of Fetal Monitoring

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 child.

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 its specificity.

The obstetric use of continuous electronic fetal heart rate monitoring increased rapidly.8901, 9301

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 scientifically.

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.

Women's Health

women's health


INTRAPARTUM FETAL MONITORING

FETAL HEART RATE

Cardiotocograph - CTG

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 treatment.

David Viniker retired from active clinical practice in 2012.
In 1999, he setup this website - www.2womenshealth.com - to provide detailed
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