Abnormal antepartum fetal heart rate tracings, failure to intervene, and fetal death: review of five cases reveals potential pitfalls of antepartum monitoring programs.

The goal of antepartum fetal heart rate monitoring is to identify which infants among high-risk obstetric patients are at risk for intrauterine death and which are not. Effective programs, by appropriately selecting cases for intervention and nonintervention, should contribute to lowering of perinatal morbidity and mortality rates. A review of five fetal deaths preceded by abnormal antepartum FHR tracings suggests effective programs require strict control. Individuals performing the testing should be experienced and knowledgeable in regard to instrumentation characteristics and recognition of normal and abnormal fetal heart rates. Dual responsibility of antepartum testing and providing primary patient care to labor and delivery patients is undesirable. Test interpretation should be based on strict criteria.