International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
Global and US standards for intrapartum surveillance of the pregnant and the fetal patient.
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Grünebaum Amos, Dudenhausen Joachim, Chervenak Frank A
Аннотация
OBJECTIVE: Cardiotocography is a dual-signal physiologic modality monitoring the pregnant and fetal patient. The objective of the present study was to compare global guidelines with the recently updated US Clinical Practice Guideline.
METHODS: A comparative analysis was conducted across global guidelines and the US guideline, evaluating three domains: uterine physiology, fetal heart rate interpretation, and management models. Definitions, interpretive structures, and triggers for intervention were compared without attempting to reconcile divergent frameworks.
RESULTS: Global guidelines (cardiotocography) define uterine activity across multiple physiologic parameters and integrate these with fetal heart rate to assess the maternal-fetal unit as a single physiologic system. In contrast, the US guideline (fetal monitoring) defines tachysystole but does not explicitly define additional uterine physiologic parameters, and intervention is recommended when tachysystole is associated with fetal heart rate abnormalities rather than as an independent physiologic trigger. Global frameworks interpret fetal heart rate patterns within uterine context, whereas the US guideline emphasizes pattern recognition with limited formal integration of uterine physiology. These differences result in a preventive model in global guidelines and a comparatively reactive model in the US guideline.
CONCLUSION: Intrapartum surveillance functions most effectively when uterine activity and fetal heart rate are interpreted as components of a maternal-fetal physiologic system. The US guideline provides detailed fetal definitions but leaves most uterine physiologic elements unspecified. Reintegration of explicit uterine physiologic definitions may improve physiologic coherence and support earlier intervention.
METHODS: A comparative analysis was conducted across global guidelines and the US guideline, evaluating three domains: uterine physiology, fetal heart rate interpretation, and management models. Definitions, interpretive structures, and triggers for intervention were compared without attempting to reconcile divergent frameworks.
RESULTS: Global guidelines (cardiotocography) define uterine activity across multiple physiologic parameters and integrate these with fetal heart rate to assess the maternal-fetal unit as a single physiologic system. In contrast, the US guideline (fetal monitoring) defines tachysystole but does not explicitly define additional uterine physiologic parameters, and intervention is recommended when tachysystole is associated with fetal heart rate abnormalities rather than as an independent physiologic trigger. Global frameworks interpret fetal heart rate patterns within uterine context, whereas the US guideline emphasizes pattern recognition with limited formal integration of uterine physiology. These differences result in a preventive model in global guidelines and a comparatively reactive model in the US guideline.
CONCLUSION: Intrapartum surveillance functions most effectively when uterine activity and fetal heart rate are interpreted as components of a maternal-fetal physiologic system. The US guideline provides detailed fetal definitions but leaves most uterine physiologic elements unspecified. Reintegration of explicit uterine physiologic definitions may improve physiologic coherence and support earlier intervention.