British Journal zyxwvutsrqp of Obstetrics and Gynaecology Junc 1990, Vol. zyxwvutsrq Y7, zyxwvutsrq pp. 47Wt79 Birth asphyxia and the intraparturn cardiotocograph KARL WILLIAM MURPHY, PAUL JOHNSON, JAMES MOORCRAFT, ROBERT PATTINSON, VIRGINIA RUSSELL, SIR ALEXANDER TURNBULL Summary. The intrapartum cardiotocographs (CTGc) of 38 severely asphyxiated, term infants, born during a 17-month period, and those of 120 healthy term infants acting as controls were independently reviewed by threc investigators who were unaware of the clinical outcome. Inter- observcr agreement was good (Kappa statistic = 0.74, P<O-O001). The investigators found that cardiotocographic abnormalities were present in 33 of the asphyxiated infants (87%) and in 35 of the controls (29%) and predicted that the abnormalities were severe enough to lead to sig- nificant fetal metabolic acidosis at delivery in 23 asphyxiated infants (61%) and in 11 controls (9%). The differences between the two groups were highly significant (P<O401). Using the traditional diagnostic cri- teria for fetal distrcss, the invehtigators iound that fetal blood sampling was indicated in 58% of cases in the asphyxia group and in 20% of con- trols but was only performed in 16%) of asphyxiated infants and in 8% of control?. Furthermore, the median response times of delivery suite staff for abnormal fctal heart rate patterns were similar whether the FHR changes, classified using Krcbs’ CTG scoring system, were modcratc or severe: 80 min and 90 miii, respectively. These findings suggest that interpretation of the intrapartum CTG continues to pose major prob- lems for practising obstetricians. Continuous elcctronic fctal heart rate (FHR) monitoring III labour has become an integral part Nuffield Department of Obstetrics and Gynaecology, Maternity Department, John Radcliffe Hospital, Headington, Oxford OX3 9DU KARL WTLI TAM MURPHY PAUL JOHNSON VIRGTNIA RUSSELL SIR ALEXANDFR TURNRULT Department of Neonatology, John Radcliffe Hospital, Headington, Oxford OX3 9DU JAMES MOORCRAbT Department of Obstetrics and Gynaecologj, University of Stellenbosch Medical School, PO Box 63, ‘lygerberg 7505, South Africa KOBhRI PAT1 INSON Correywndence Dr Paul Johnson 470 of obstetric practice since its introduction in the 1960s (Steer 1982) despite the fact that no clear evidence exists for its efficacy, especially in low- risk pregnancy. A study by Sykes zyx et al. (1983) in a major UK teaching hospital showed that the use of the intraparturn cardiotocograph (CTG) for predicting low pH at birth was poor and the authors called for more frequent and sensible usage of fetal blood sampling (FRS) until bettcr methods of intraparturn fetal monitoring become available. It was subsequently suggcstcd that poor prediction might be due to failure of interpretation rather than lailure of the tecli- nology (Stecr 1986; Van Den Berg 1987). Any benefit from continuous CTG monitoring must depend on the ability of midwives and obstetricians in the delivery unit to interpret very complex and confusing FHR patterns and