Fetal Heart Rate Monitoring : Clinical Practice and Pathophysiology

In the past decade fetal heart rate monitoring has become a generally ac­ cepted method for fetal surveillance during pregnancy and labor. Although its importance has been doubted recently, I personally feel that this method has become an important obstetric tool. It has not only improved our knowledge about fetal behavior and fetal condition throughout gesta­ tion, but it has especially improved fetal surveillance during labor; the most dangerous period of human life has never been as safe as nowadays. The only people who can question the advantage of fetal heart rate moni­ toring are those who did not experience the period before fetal heart rate monitoring was generally introduced. The first paper on the history of fetal heart rate monitoring takes us back to the beginning of fetal surveillance and provides an introduction to the different aspects of fetal observation which are covered later in this volume. Common practices of fetal surveillance in different countries are discussed, and the paths that future developments will take are suggested. An outline of the physiological aspects of fetal heart rate regulation is fol­ lowed by discussion of the pathophysiology with which the obstetrician is very often confronted. Front Matter....Pages I-XII Front Matter....Pages 1-1 History of Fetal Heart Rate Monitoring....Pages 3-15 Necessity of Fetal Heart Rate Monitoring from a Dutch Point of View....Pages 16-21 Changing Trends of Fetal Heart Rate Monitoring in the United States....Pages 22-33 The Dublin Randomised Controlled Trial of Intrapartum Electronic Fetal Heart Rate Monitoring....Pages 34-39 The Use of Fetal Surveillance During Labor in the Federal Republic of Germany....Pages 40-52 Present and Future Technical Advances in Fetal Heart Rate Monitoring....Pages 53-60 Front Matter....Pages 61-61 Antenatal Heart Rate Analysis at the Bedside Using a Microprocessor....Pages 63-65 Fetal Hemodynamic Alterations During Advancing Gestation....Pages 66-69 Front Matter....Pages 71-71 Incidence and Pattern of Fetal Heart Rate Alterations During Labor....Pages 73-81 Fetal Hemodynamic Responses to Reduced Uterine Blood Flow in the Sheep Fetus....Pages 82-93 Variability of Fetal Heart Rate Deceleration, Blood Pressure, and Acid Base Alterations During Defined Repetitive Hypoxic Stress....Pages 94-103 Fetal Heart Rate Response to Hypoxia in the Subhuman Primate....Pages 104-113 Fetal Heart Rate Alterations in Partial and Total Cord Occlusion....Pages 114-124 Front Matter....Pages 125-125 Adrenal-Medullary Activity and Cardiovascular Control in the Fetal Sheep....Pages 127-135 The Dip Area: A Measure of Acid Base Alterations?....Pages 136-143 Fetal Heart Rate and Fetal Deterioration: Clinical and Experimental Observations....Pages 144-160 Kinetics of Lactic Acid Accumulation and Removal in the Fetus....Pages 161-169 Pharmacological Aspects of Fetal Heart Rate Regulation During Hypoxia....Pages 170-184 Front Matter....Pages 185-185 The Control of Fetal Heart Rate and Its Variability in Lambs....Pages 187-190 Short- and Long-Term Variability in Fetal Heart Rate Pattern and Its Relation to Basal Heart Frequency....Pages 191-200 Front Matter....Pages 185-185 Long-Term Observation of Fetal Heart Rate Irregularities....Pages 201-211 Fetal Heart Rate Patterns in Experimental Intrauterine Growth Retardation....Pages 212-222 Chemoreceptor and Baroreceptor Function with Respect to Fetal Heart Rate Variability....Pages 223-233 Blood Flow Measurements in the Human Fetus....Pages 234-239 Back Matter....Pages 240-244