Sir, Recently, Kaasen et al described clinical routines for intrapartum fetal monitoring in all Norwegian birth units.1 All units had a Pinard stethoscope, handheld Doppler and cardiotocography (CTG). Half of the units used ST waveform analysis (STAN), and 48% had access to fetal scalp blood sampling, most often for lactate analysis. Umbilical cord blood gas analyses were performed in 90% of the units, most often after high‐risk deliveries. Some deviations from national rec‐ ommendations were observed. Admission CTG was used routinely in low‐risk women in 23% of the birth units. Use of intermittent auscultation of the fetal heart with a Pinard stethoscope, handheld Doppler or external CTG transducer differed among units, as did the time intervals between auscultation both in the first and second stage of labor in low‐risk pregnancies. The definitions of slow prog‐ ress of labor were also not consistent. Describing the routines for intrapartum fetal monitoring is not sufficient if they are not followed and not used for proper indica‐ tions. Therefore, the knowledge of how often these routines are or are not followed in clinical practice and why, is of utmost impor‐ tance. However, we have very little information on these, both at a national and international level. Admission CTG is not recommended in Norway in low‐risk women as it is generally accepted that there is no evidence for its use.1‐3 Nonetheless, it is routinely used in 23% of the birth units. Admission CTG is not recommended by the WHO, in the UK, Canada, Australia, New Zealand or Denmark.1 However, in Sweden, is it widely used. Why is it so? Recently, Swedish researchers discussed why they deemed admission CTG beneficial in a retrospective, hos‐ pital‐based study including both low‐ and high‐risk pregnancies, many with signs of placental abruption at admission.4 In my opinion, results from such a study do not justify their conclusions. On the other hand, Sweden does not use STAN technology, whereas many units in Norway do. Since the STAN algorithm is based on a modified, old version of the FIGO guideline for CTG in‐ terpretation, the new FIGO guidelines from 2015 were not intro‐ duced in Norway, as they are in Sweden in a slightly modified form. There is sufficient evidence that STAN is not superior to CTG alone or combined with fetal blood sampling for any important clinical out‐ comes.5 STAN can only be used after 36 weeks of gestation, only after rupture of membranes and has a complex algorithm; in addition many clinicians do not trust it to give a significant warning/alarm at an appropriate time. Thus, it is striking how traditions and beliefs, rather than evidence, continue to influence the method chosen for fetal monitoring. In Norway, the Pinard stethoscope appears to have been re‐ placed by handheld Doppler or an external CTG probe.6 In my opinion, this is not well founded, since the Pinard stethoscope may be better at avoiding misidentification of maternal heart rate as a falsely reassuring fetal heart rate. There are too many court cases and claims for compensation after birth injury to the child where handheld Doppler or external CTG probe have produced a falsely reassuring fetal heart rate trace. Of course, if in doubt, a real‐time ultrasound machine should be used. The publication by Kaasen et al1 should be followed by new stud‐ ies evaluating why different methods for fetal monitoring are used, the rationale for the decision, and how these routines are followed and implemented in clinical practice.

中文翻译：

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产时胎儿监测的常规很重要，但为什么以及如何使用它们更重要

先生，最近，Kaasen 等人描述了所有挪威分娩单位的产时胎儿监护的临床程序。1 所有单位都配备了 Pinard 听诊器、手持式多普勒和胎心监护 (CTG)。一半的单位使用 ST 波形分析 (STAN)，48% 的单位可以获得胎儿头皮血样，最常用于乳酸分析。90% 的单位都进行了脐带血气体分析，最常见的是在高危分娩之后。观察到与国家建议的一些偏差。入院 CTG 常规用于 23% 的分娩单位的低危女性。使用皮纳德听诊器、手持式多普勒或体外 CTG 换能器间歇性听诊胎心的使用因单位而异，低危妊娠的第一和第二产程听诊之间的时间间隔也不同。分娩进展缓慢的定义也不一致。如果没有遵循和没有用于适当的指征，那么描述产时胎儿监测的程序是不够的。因此，了解在临床实践中遵循或不遵循这些程序的频率以及原因至关重要。然而，我们在国家和国际层面上的信息很少。挪威不建议低危女性使用 CTG，因为人们普遍认为没有使用 CTG 的证据。1-3 尽管如此，23% 的分娩单位仍常规使用 CTG。WHO 不推荐入院 CTG，在英国、加拿大、澳大利亚、新西兰或丹麦。1 但是在瑞典，它被广泛使用。为什么会这样？最近，瑞典研究人员讨论了为什么他们认为入院 CTG 在一项回顾性、基于医院的研究中有益，包括低风险和高风险妊娠，其中许多在入院时有胎盘早剥的迹象。 4 在我看来，此类研究的结果并不证明他们的结论。另一方面，瑞典不使用 STAN 技术，而挪威的许多单位使用。由于 STAN 算法基于经过修改的旧版 FIGO CTG 解释指南，因此 2015 年的新 FIGO 指南并未在挪威引入，因为它们在瑞典以略微修改的形式引入。有足够的证据表明 STAN 在任何重要的临床结果方面并不优于单独使用 CTG 或联合胎儿采血。5 STAN 只能在妊娠 36 周后使用，只有在破膜后才具有复杂的算法；此外，许多临床医生不相信它会在适当的时候发出重要警告/警报。因此，令人惊讶的是传统和信仰，而不是证据，如何继续影响选择的胎儿监测方法。在挪威，Pinard 听诊器似乎已被手持多普勒或外部 CTG 探头取代。 6 在我看来，这并没有充分根据，因为 Pinard 听诊器可能更能避免将孕妇心率误判为误诊。安心胎心率。手持多普勒或体外CTG探头产生虚假的胎心率轨迹，导致儿童产伤后赔偿的法庭案件和索赔太多。当然，如果有疑问，应该使用实时超声机。