Antecedents of neonatal encephalopathy with fetal acidaemia at term



The authors of this paper (Vol 106 August 1999)1 are to be commended for their frank exposition of the need for improved fetal monitoring practice. It seems relevant to the concerns they have expressed to point out that a considerable proportion of the “cardiotocographic” recordings which illustrate the article do not include a satisfactory tocographic trace. Thus Figures 1b, 2a and 2b have no tocogram, while Figures 3 and 4b provide little or no reliable information about the pattern and timing of uterine activity.

Without clear identification of the time of onset, acme and end of contractions, the interpretation of fetal heart rate decelerations becomes mere guesswork. It has been my experience that the absence of a properly adjusted tocogram can contribute significantly to failure to recognise fetal compromise. While attention is focused on obtaining a fetal heart rate trace of good quality, the toco transducer is a likely source of discomfort as labour proceeds, and midwives can be tempted to slacken the belt, so vitiating the recording.

Cardiotocography is a long, clumsy term, but its use is necessary if only to remind staff that more than fetal heart rate recording is involved in monitoring the condition of the infant.