Abstract
Objective: This article provides recommendations pertaining to the application and documentation of fetal surveillance in the intrapartum period that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. Methods: This study reviews the techniques currently used to assess fetal well-being during the passage from intrauterine to extrauterine life. The strengths of the various surveillance modalities are highlighted, as are the limitations inherent in each. Results: Continuous intrapartum electronic fetal monitoring (EFM) practices are emphasized, but the utility and efficacy of adjunctive measures, including fetal scalp pH sampling and evoked fetal responses, are also reviewed. Short- and long-term outcomes that may indicate the presence of birth asphyxia were considered. The associated rates of operative and other labour interventions were also considered. Discussion: Despite the control of fetal well-being during labor reduced perinatal asphyxia remains a very small but important percentage of cases that do not currently seem possible to permanently delete. One of the biggest challenges faced daily by obstetricians is to provide to each couple, one child neurologically vigorous and healthy. This result also passes through the improvement of methods of intrapartum fetal monitoring process.
Objective: This article provides recommendations pertaining to the application and documentation of fetal surveillance in the intrapartum period that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention.
Methods: This study reviews the techniques currently used to assess fetal well-being during the passage from intrauterine to extrauterine life. The strengths of the various surveillance modalities are highlighted, as are the limitations inherent in each.
Results: Continuous intrapartum electronic fetal monitoring (EFM) practices are emphasized, but the utility and efficacy of adjunctive measures, including fetal scalp pH sampling and evoked fetal responses, are also reviewed. Short- and long-term outcomes that may indicate the presence of birth asphyxia were considered. The associated rates of operative and other labour interventions were also considered.
Discussion: Despite the control of fetal well-being during labor reduced perinatal asphyxia remains a very small but important percentage of cases that do not currently seem possible to permanently delete. One of the biggest challenges faced daily by obstetricians is to provide to each couple, one child neurologically vigorous and healthy. This result also passes through the improvement of methods of intrapartum fetal monitoring process.
Riassunto
Obiettivi: Questo articolo fornisce raccomandazioni relative all'applicazione ed alla documentazione delle metodiche relative alla sorveglianza fetale intrapartum che hanno come obiettivo quello di ridurre l'incidenza di asfissia alla nascita mantenendo il tasso più basso possibile di interventi ostetrici. Metodi: Lo studio esamina le tecniche attualmente utilizzate per valutare il benessere fetale durante il passaggio dalla vita intrauterina a quella extrauterina. Vengono evidenziati i punti di forza delle varie modalità di sorveglianza , così come i limiti insiti in ciascuna. Risultati: L’utilità del monitoraggio fetale elettronico continuo intrapartum (EFM) viene enfatizzato, ma sono anche valutate l'utilità e l'efficacia di misure aggiuntive, quali il pH da prelievo dello scalpo fetale e le risposte evocate fetali da stimolazione. Sono stati considerati gli outcome a breve e a lungo termine che possono indicare la presenza di asfissia alla nascita. Inoltre, sono stati considerati i tassi di interventi operativi in travaglio. Discussione: Nonostante il controllo del benessere fetale durante il travaglio ha ridotto l’asfissia perinatale, rimane una percentuale molto piccola ma importante di casi che attualmente non sembra possibile eliminare definitivamente. Una delle maggiori sfide che gli ostetrici affrontano quotidianamente è quello di assicurare ad ogni coppia, un bambino vigoroso e neurologicamente sano. Questo risultato passa anche attraverso il miglioramento delle metodiche del processo di monitoraggio fetale intrapartum.