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Fetal Compromise in Labor

Mark I. Evans, Lawrence D. Devoe, Philip J. Steer
Published online:

15 January 2025

Print publication:

13 February 2025
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Sixty years ago, the purpose of introducing electronic fetal heart rate monitoring (EFM) was to reduce the incidence of intrapartum stillbirth. However, by the early 1980s, with falling stillbirth rates, fetal blood sampling had been widely abandoned, as many considered that EFM was sufficient on its own. Unfortunately, while the sensitivity of EFM for the detection of potential fetal compromise is high, specificity is low, and there is a high false positive rate which has been associated with a rising cesarean section rate. The authors suggest that EFM is considered and analyzed as a classic screening test and not a diagnostic test. Furthermore, it requires contextualization with other risk factors to achieve improved performance. A new proposed metric, the Fetal Reserve Index, takes into account additional risk factors and has demonstrated significantly improved performance metrics. It is going through the phases of further development, evaluation, and wider clinical implementation.

Chapter 61 - Dysfunctional Labor (Content last reviewed: 20th February 2020)
from Section 6 - Late Prenatal – Obstetric Problems
- By James S. McLaren, Philip J. Steer
Edited by David James, University of Nottingham, Philip Steer, Imperial College London, Carl Weiner, University of Kansas, Bernard Gonik, Wayne State University, Detroit, Stephen Robson
Book:

High-Risk Pregnancy

Published online:

15 November 2017, pp 1749-1774
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Summary

The primary goal for all involved in the care of women in labor is a healthy mother and baby after delivery. For most pregnancies, which are low risk, delivery by cesarean section appears to pose greater risk of maternal morbidity and mortality than vaginal delivery and can have significant implications for future pregnancies.

Chapter 59 - Prolonged Pregnancy
from Section 6 - Late Prenatal – Obstetric Problems
- By Imelda Balchin, Andrew C. G. Breeze, Philip J. Steer
Edited by David James, University of Nottingham, Philip Steer, Imperial College London, Carl Weiner, University of Kansas, Bernard Gonik, Wayne State University, Detroit, Stephen Robson
Book:

High-Risk Pregnancy

Published online:

15 November 2017, pp 1696-1707
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Summary

Prolonged or post-term pregnancies are associated with an increased risk of perinatal mortality and morbidity when compared with pregnancies ending at term. This adverse outcome is mainly associated with placental insufficiency, meconium aspiration syndrome, macrosomia, and birth injury.

Chapter 63 - Fetal Compromise in Labor (Content last reviewed: 15th December 2018)
from Section 6 - Late Prenatal – Obstetric Problems
- By Philip J. Steer, Edwin Chandraharan
Edited by David James, University of Nottingham, Philip Steer, Imperial College London, Carl Weiner, University of Kansas, Bernard Gonik, Wayne State University, Detroit, Stephen Robson
Book:

High-Risk Pregnancy

Published online:

15 November 2017, pp 1788-1809
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Summary

For many years it was taken to indicate the presence of hypoxia, leading to fetal acidosis. However, we have become more aware of the importance to the fetus of variables such as maternal/fetal temperature, chorioamnionitis, passage of meconium into the amniotic fluid (which can lead to meconium aspiration syndrome), and trauma, including events such as cord prolapse and head compression (which can occur from excessive molding even in spontaneous labor, but is more commonly associated with forceps and difficult cesarean deliveries).

Chapter 24 - How to Write a Medical Research Paper and Get It Accepted for Publication
- By Philip J. Steer
Edited by P. M. Shaughn O'Brien, Fiona Broughton Pipkin, University of Nottingham
Book:

Introduction to Research Methodology for Specialists and Trainees

Published online:

04 August 2017

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17 August 2017, pp 188-195
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Section 4 - Antenatal Care: Specific Maternal Conditions
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

Published online:

05 March 2016

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17 March 2016, pp 106-207
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Section 6 - Postpartum Care
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

Published online:

05 March 2016

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17 March 2016, pp 218-239
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Appendix B - Antenatal care pathway
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

Published online:

05 March 2016

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17 March 2016, pp 241-254
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List of contributors
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

Published online:

05 March 2016

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17 March 2016, pp vi-viii
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Section 1 - Pregnancy Counseling and Contraception
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

Published online:

05 March 2016

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17 March 2016, pp 1-18
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Copyright page
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

Published online:

05 March 2016

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17 March 2016, pp iv-iv
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Contents
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

Published online:

05 March 2016

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17 March 2016, pp v-v
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Section 2 - Antenatal Care: General Considerations
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

Published online:

05 March 2016

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17 March 2016, pp 19-83
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Section 3 - Antenatal Care: Fetal Considerations
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

Published online:

05 March 2016

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17 March 2016, pp 84-105
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Preface
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

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05 March 2016

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17 March 2016, pp ix-ix
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Consensus statements
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

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05 March 2016

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17 March 2016, pp x-xiv
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Plate section
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

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05 March 2016

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17 March 2016, pp 266-267
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Index
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

Published online:

05 March 2016

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17 March 2016, pp 255-265
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Section 5 - Intrapartum Care
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

Published online:

05 March 2016

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17 March 2016, pp 208-217
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Appendix A - New York Heart Association classification of cardiovascular disease
Edited by Philip J. Steer, Michael A. Gatzoulis
Book:

Heart Disease and Pregnancy

Published online:

05 March 2016

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17 March 2016, pp 240-240
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Fetal Compromise in Labor

Chapter 61 - Dysfunctional Labor (Content last reviewed: 20th February 2020)

Summary

Chapter 59 - Prolonged Pregnancy

Summary

Chapter 63 - Fetal Compromise in Labor (Content last reviewed: 15th December 2018)

Summary

Chapter 24 - How to Write a Medical Research Paper and Get It Accepted for Publication

Section 4 - Antenatal Care: Specific Maternal Conditions

Section 6 - Postpartum Care

Appendix B - Antenatal care pathway

List of contributors

Section 1 - Pregnancy Counseling and Contraception

Copyright page

Contents

Section 2 - Antenatal Care: General Considerations

Section 3 - Antenatal Care: Fetal Considerations

Preface

Consensus statements

Plate section

Index

Section 5 - Intrapartum Care

Appendix A - New York Heart Association classification of cardiovascular disease

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22 results

Fetal Compromise in Labor

Summary

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