The persistent challenge of foetal heart rate monitoring.

PURPOSE OF REVIEW: To analyse the reasons why foetal heart rate (FHR) monitoring failed to fulfil the initial expectations of unequivocally decreasing perinatal morbidity and mortality, and to summarize the most recent advances in this field.

RECENT FINDINGS: It is now clear that expectations towards FHR monitoring at the time of its introduction into clinical practice were unrealistic. Several pitfalls in FHR monitoring have been identified, and solutions established to avoid them. Correct use of FHR equipment and adequate tracing recording are as important as analysis and interpretation. New methods of computerized FHR analysis have been developed, and wide clinical validation of these is currently ongoing. More concrete guidelines on future research and development, as well as on regular training of healthcare professionals have been produced.

SUMMARY: FHR monitoring needs to be used with realistic expectations. Acquisition, storage and analysis of tracings according to available guidelines need to be guaranteed. Integration of data with foetal blood sampling and foetal ECG analysis during labour, and with umbilical artery blood flow analysis or the biophysical profile in the antepartum period, may further improve clinical decisions. Central monitoring stations and computer analysis are becoming more widespread and are currently undergoing wide clinical evaluation. Research, development and training need to take into account recent guidelines outlining the main issues in these fields.