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Improving The Interpretation of Electronic Fetal Monitoring: The Fetal Reserve Index

The document discusses the challenges and advancements in electronic fetal monitoring, particularly focusing on the newly developed Fetal Reserve Index, which aims to improve the identification of at-risk infants during labor. It highlights the limitations of traditional monitoring methods and presents evidence that the Fetal Reserve Index can more accurately predict outcomes such as cerebral palsy and reduce unnecessary cesarean deliveries. The findings suggest a need for closer neonatal observation in the immediate post-delivery period to mitigate risks of neurologic impairment.

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14 views2 pages

Improving The Interpretation of Electronic Fetal Monitoring: The Fetal Reserve Index

The document discusses the challenges and advancements in electronic fetal monitoring, particularly focusing on the newly developed Fetal Reserve Index, which aims to improve the identification of at-risk infants during labor. It highlights the limitations of traditional monitoring methods and presents evidence that the Fetal Reserve Index can more accurately predict outcomes such as cerebral palsy and reduce unnecessary cesarean deliveries. The findings suggest a need for closer neonatal observation in the immediate post-delivery period to mitigate risks of neurologic impairment.

Uploaded by

pipe02c
Copyright
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Review Am J Obstet Gynecol. 2023 May;228(5S):S1129-S1143.


doi: 10.1016/j.ajog.2022.11.1275. Epub 2023 Mar 17.

Improving the interpretation of electronic fetal


monitoring: the fetal reserve index
Mark I Evans 1 , David W Britt 2
, Shara M Evans 3
, Lawrence D Devoe 4

Affiliations
PMID: 37164491 DOI: 10.1016/j.ajog.2022.11.1275

Abstract
Electronic fetal monitoring, particularly in the form of cardiotocography, forms the centerpiece of
labor management. Initially successfully designed for stillbirth prevention, there was hope to also
include prediction and prevention of fetal acidosis and its sequelae. With the routine use of
electronic fetal monitoring, the cesarean delivery rate increased from <5% in the 1970s to >30% at
present. Most at-risk cases produced healthy babies, resulting in part from considerable confusion
as to the differences between diagnostic and screening tests. Electronic fetal monitoring is clearly a
screening test. Multiple attempts have aimed at enhancing its ability to accurately distinguish
babies at risk of in utero injury from those who are not and to do this in a timely manner so that
appropriate intervention can be performed. Even key electronic fetal monitoring opinion leaders
admit that this goal has yet to be achieved. Our group has developed a modified approach called
the "Fetal Reserve Index" that contextualizes the findings of electronic fetal monitoring by formally
including the presence of maternal, fetal, and obstetrical risk factors and increased uterine
contraction frequencies and breaking up the tracing into 4 quantifiable components (heart rate,
variability, decelerations, and accelerations). The result is a quantitative 8-point metric, with each
variable being weighted equally in version 1.0. In multiple previously published refereed papers, we
have shown that in head-to-head studies comparing the fetal reserve index with the American
College of Obstetricians and Gynecologists' fetal heart rate categories, the fetal reserve index more
accurately identifies babies born with cerebral palsy and could also reduce the rates of emergency
cesarean delivery and vaginal operative deliveries. We found that the fetal reserve index scores and
fetal pH and base excess actually begin to fall earlier in the first stage of labor than was commonly
appreciated, and the fetal reserve index provides a good surrogate for pH and base excess values.
Finally, the last fetal reserve index score before delivery combined with early analysis of neonatal
heart rate and acid/base balance shows that the period of risk for neonatal neurologic impairment
can continue for the first 30 minutes of life and requires much closer neonatal observation than is
currently being done.
:
Keywords: acidosis; augmented electronic fetal monitoring; base excess; cardiotocography;
category system; cerebral palsy; electronic fetal monitoring; fetal reserve index; fetal scalp; keeping
labor safe; pH; risk factors; sampling.

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