Introduction
Fetal surveillance during labor is primarily based on fetal heart rate (FHR) analysis. The purpose of the interpretation of the FHR is to detect signs of poor fetal tolerance and therefore situations at risk of fetal acidosis. Indeed, this acidosis can be responsible for morbidity and perinatal mortality including motor disability of cerebral origin (1). In these intermediate-risk situations of fetal acidosis, second-line methods exist such as fetal scalp sampling (pH or lactate measurement) or ST segment analysis (2–4).
Interpretation of abnormalities observed on the FHR or second-line exams requires knowledge of fetal physiology during labor (5,6). The recent FIGO recommendations modified in 2015 classify the FHR as normal, suspicious or pathological, leading to a more physiological analysis of the FHR. (7). On the other hand, the place of second-line exams is controversial. In fact, a US randomized study concluded that ST segment analysis was not helpful in preventing fetal acidosis and nor in reducing intervention (cesarean or instrumental extraction) (8). Moreover, the physiopathology and the interest of fetal blood scalp sampling are discussed (9). Therefore, it is proposed to improve the quality of the interpretation of the FHR thanks to a better knowledge of the fetal physiology and of the adaptation of the fetus to the hypoxemia during labor. Thus, the aim of the present study was to assess fetal physiology training in terms of theoretical knowledge, interpretation of FHR and use of second-line examination.