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Electronic fetal monitoring or cardiotocography, 50 years later: what's in a name?

2018; Elsevier BV; Volume: 218; Issue: 6 Linguagem: Inglês

10.1016/j.ajog.2018.03.011

1097-6868

Diogo Ayres‐de‐Campos,

Neuroscience of respiration and sleep

Almost 350 years ago, fetal heart sounds were first described by the French physician Marsac, but it took another 150 years before fetal auscultation using mechanical stethoscopes entered routine clinical practice in western Europe and North America.1Gultekin-Zootzmann B. The history of monitoring the human fetus.J Perinat Med. 1975; 3: 135-144Crossref PubMed Scopus (18) Google Scholar The use of electronic methods for acquiring and recording fetal heart rate (FHR) and uterine contraction (UC) signals is a much more recent event. Consistent methods for acquiring FHR and UC signals were first described by Edward Hon,2Hon E. Apparatus for continuous monitoring of the fetal heart rate.Yale J Biol Med. 1960; 32: 397-399PubMed Google Scholar Roberto Caldeyro-Barcia,3Alvarez H. Caldeyro-Barcia R. The normal and abnormal contractile waves of the uterus during labour.Gynaecologia. 1954; 138: 190-212PubMed Google Scholar and Konrad Hammacher4Hammacher K. New method for the selective registration of the fetal heart beat.Geburtshilfe Frauenheilkd. 1962; 22: 1542-1543PubMed Google Scholar in the 1950s and early 1960s, and this eventually led to the development of the first commercial fetal monitor in 19685Freeman R.K. Garite T.J. History of fetal monitoring.in: Freeman R.K. Garite T.J. Fetal heart rate monitoring. William & Wilkins, Baltimore1981Google Scholar (Figure). Electronics is a branch of physics that deals with the emission, behavior, and effects of electrons (as in electron tubes and transistors).6Merriam-Webster Dictionary. Available at: https://www.merriam-webster.com/dictionary/electronics. Accessed Feb. 25, 2018.Google Scholar It was mostly developed in the 20th century and allowed the invention and refinement of appliances that have markedly changed our society, such as radio, television, telephones, and computers. Integrated circuits appeared in the early 1960s and opened up a whole new era for electronic development. Electronic fetal monitoring (usually shortened to EFM) was the natural name given in the 1960s and 1970s to describe the new technology of continuously monitoring fetal heart rate and uterine contraction signals. The age of electronics was at its peak, and it was important to differentiate this technology from previously existing mechanical methods. The term gained popularity in many English-speaking countries, particularly in the United States. In other parts of the world, the technology became known as cardiotocography (usually shortened to CTG), from the Greek words kardia meaning heart and tokos meaning labor and childbirth. In the United Kingdom, both names were used interchangeably. With the passage of time, the term electronic fetal monitoring has become a misnomer. While in the early days it was indeed the only form of electronically monitoring the fetus, several other technologies for fetal surveillance involving electronics were subsequently developed: ultrasound, handheld Doppler, fetal electrocardiography, fetal pulse oximetry, etc. The terms electronic fetal monitoring and fetal heart rate monitoring also have the limitation of not fully describing the signals that are acquired, leaving out maternal uterine contractions. In 2015, the International Federation of Gynecology and Obstetrics promoted the largest international consensus to date on intrapartum fetal monitoring, with the objective of standardizing terminology, interpretation, and clinical management.7Ayres-de-Campos D. Arulkumaran S. for the FIGO Intrapartum Fetal Monitoring Expert Consensus PanelFIGO consensus guidelines on intrapartum fetal monitoring: introduction.Int J Gynecol Obstet. 2015; 131: 3-4Crossref PubMed Scopus (34) Google Scholar A total of 50 experts from all over the world participated, including many leading figures from the United States, such as Lawrence Devoe, Richard Paul, Barry Schifrin, Julian Parer, Vincenzo Berghella, and Catherine Spong. The panel agreed that cardiotocography is the term that best describes the continuous monitoring of fetal heart rate and uterine contraction signals. In 2018, we celebrate the 50th anniversary of the clinical use of FHR and UC signal monitoring, a respectable age for any technology and a sign that it has passed the test of time and gained a solid place in obstetric care. It remains at the center of the decision process in the important goal of avoiding intrapartum fetal hypoxia, and it is likely to maintain that role in the coming years. We owe it to the next generations of physicians entering our speciality to agree on a common terminology for obstetric techniques and procedures. In this era of globalization and easier access to medical information, the use of common terminology promotes better communication among health care professionals and easier transmission of knowledge. Harmonization of language is a particularly important task for English-language countries that have assumed a leading role in medical progress and dissemination. Agreeing on common terminology requires an effort to question the significance of deeply enrooted terms and to look beyond national borders, evaluating their impact on the whole international community. The term electronic fetal monitoring is of important historic significance, but it has now become outdated because it does not adequately describe nor fully represent the signals acquired by this technology. Cardiotocography is the most accurate term to replace it, and it has the advantage of already being used by a large part of the international community. Let us make an effort in 2018 to homogenize the way we call this important technology for obstetricians and in this way contribute to the celebration of its 50th anniversary.