Elective fetal monitoring and obstetrical operative frequency.

This paper reports on cardiotocographic findings after the introduction of elective fetal monitoring. A classification into the following four groups is recommended: normal, warning, severe functional hemodynamic disorders (SFHD) and hypoxia. This fetal heart frequency (FHF) classification prefers the evaluation of the effects on fetal condition compared with a descriptive classification. SFHD in the first stage of labor can be observed in 4% of parturient women, increasing to nearly 16% in the second stage. Cesarean section rate in this group amounts to 12.5% and forceps rate exceeds 50%. Under the condition of elective fetal monitoring (94% in total) and a reserved application of cesarean section (4.3% in total) and generous forceps delivery (15% in total) a perinatal mortality rate of 13% for obstetrical material with high-risk concentration is achieved. The total acidosis rate (pH less than 7.20) decreases to 2.3%, whereas the rate of severe acidosis (pH less than 7.10) was observed in only 0.4% of the cases. With elective fetal monitoring a low cesarean section rate taking critical evaluation into consideration and using all conservative methods of treatment is obtained. By means of the generous application of the single or repeated bolus injection of 25 micrograms fenoterol and the operative shortening of the second stage of labor in the case of SFHD, the neonatal morbidity can be kept at a low level. The small number of fetal or maternal complications using the direct methods of fetal supervision and the careful operative termination of labor justifies the recommended obstetrical management.