Authors' Reply



We are pleased that Dr Myerscough draws attention to another common deficiency of monitoring labour, inadequate or absent recording of uterine activity. Tocography can provide critical information in cases of excessive uterine stimulation, or prolonged contractions. However, it was not clear to us in the present study that better toco-graphic recordings would have materially improved interpretation of the fetal heart rate data. In all but one of the cases where fetal heart rate recordings of adequate quality were obtained, the tracings were severely abnormal. In most of the cases where tocography was not available, the fetal heart rate tracing was also either of poor quality or insufficient duration. As we have recently emphasised contractions are associated with a fall in fetal oxygen tension, and the frequency and duration of contractions are major determinants of fetal condition during labour1. Lack of understanding of the basic physiology of labour may underlie failure to carry out complete cardiotocography.