Continuous monitoring of the fetal heart rate in labor is widespread, but the benefits of this practice to the fetus have been questioned. The present authors report a prospective study of 6825 consecutive labors in which they compared the clinical condition of babies who were delivered operatively because of fetal distress diagnosed by cardiotocography, and babies whose cardiotocograph tracings had been normal.The 6825 deliveries took place between January 1, 1978 and December 31, 1982. Continuous monitoring of the fetal heart rate by cardiotocography was used in 5962 (87.4 per cent) of these cases. Table 1 shows the relation between the cardiotocograph tracing in labor and the condition of the infant at birth. In 492 labors (8.3 per cent), operative delivery was undertaken because of abnormal tracings.Forty-three babies (35.2 per cent) who needed intermittent positive pressure ventilation and 92 (20.0 per cent) of those who did not (but who had Apgar scores of less than 7) were delivered operatively because of abnormal tracings. The sensitivity of cardiotocography for all babies with Apgar scores of less than 7 was 23.2 per cent.Of the babies delivered operatively because of abnormal tracings, 43 (8.7 per cent) needed intermittent positive pressure ventilation and 92 (18.7 per cent) did not (but had Apgar scores of less than 7). The positive predictive value of cardiotocography for all babies with Apgar scores of less than 7 was 27.4 per cent. Of the 5379 labors in which the babies had Apgar scores of 7 or over, 5022 (93.4 per cent) had normal cardiotocograph tracings.
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