Electronic fetal monitoring (EFM) was introduced into obstetric practice in 1970 as a test to identify early deterioration of fetal acid-base balance in the expectation that prompt intervention (“rescue”) would reduce neonatal morbidity and mortality. Clinical trials using a variety of visual or computer-based classifications and algorithms for intervention have failed repeatedly to demonstrate improved immediate or long-term outcomes with this technique, which has, however, contributed to an increased rate of operative deliveries (deemed “unnecessary”). In this review, we discuss the limitations of current classifications of FHR patterns and management guidelines based on them. We argue that these clinical and computer-based formulations pay too much attention to the detection of systemic fetal acidosis/hypoxia and too little attention not only to the pathophysiology of FHR patterns but to the provenance of fetal neurological injury and to the relationship of intrapartum injury to the condition of the newborn. Although they do not reliably predict fetal acidosis, FHR patterns, properly interpreted in the context of the clinical circumstances, do reliably identify fetal neurological integrity (behavior) and are a biomarker of fetal neurological injury (separate from asphyxia). They provide insight into the mechanisms and trajectory (evolution) of any hypoxic or ischemic threat to the fetus and have particular promise in signaling preventive measures (1) to enhance the outcome, (2) to reduce the frequency of “abnormal” FHR patterns that require urgent intervention, and (3) to inform the decision to provide neuroprotection to the newborn.

胎儿电子监护 (EFM) 于 1970 年被引入产科实践，作为一种检测胎儿酸碱平衡早期恶化的测试，期望及时干预（“救援”）能够降低新生儿发病率和死亡率。使用各种视觉或基于计算机的分类和算法进行干预的临床试验多次未能证明该技术可以改善近期或长期结果，然而，这却导致了手术分娩率的增加（被认为是“不必要的”） ）。在这篇综述中，我们讨论了当前胎心率模式分类的局限性以及基于它们的管理指南。我们认为，这些临床和基于计算机的公式过于关注胎儿全身性酸中毒/缺氧的检测，而不仅关注胎心率模式的病理生理学，而且关注胎儿神经损伤的根源以及产时损伤的关系根据新生儿的情况。尽管它们不能可靠地预测胎儿酸中毒，但在临床情况下正确解释的胎心率模式确实可以可靠地识别胎儿神经完整性（行为），并且是胎儿神经损伤（与窒息分开）的生物标志物。它们提供了对胎儿任何缺氧或缺血威胁的机制和轨迹（演变）的深入了解，并且在发出预防措施信号方面具有特别的前景：（1）增强结果，（2）减少“异常”胎心率模式的频率需要紧急干预，以及 (3) 告知为新生儿提供神经保护的决定。