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.