Intensive care in labour: a preliminary appraisal

This is a preliminary investigation into the value, function and practicability of an intensive care labour unit for highrisk cases. All the equipment necessary can be mounted on two standard theatre trolleys which can be moved to the patient's bedside, but there is no place at present for this equipment outside a teaching unit. The investigation reports on continuous foetal heart monitoring of 36 patients and simultaneous foetal scalp pH estimations on 16 of them. A high proportion of babies with low Apgar scores showed one of two (or both) characteristic foetal heart patterns during labour: (a) the well-known type 2 dip, (b) a steppe pattern not previously described as such. The latter is of importance because it is impossible to detect using only clinical methods.There was poor correlation between foetal pH values and Apgar rating, and between foetal pH values and monitor patterns. Moreover, the pH values of foetal scalp blood and foetal umbilical arterial and venous blood samples bore varying relations to one another. However, for practical purposes, a foetal scalp blood of pH less than 7·20 when associated with a maternofoetal pH difference of 0·250 or more should be regarded with anxiety. The place and value of intensive care are discussed