Parulekar SV

We are happy that we have successfully completed four years of publication of the journal. We feel that it is a significant achievement, as all work is done by clinicians taking out time from their private time, spending their own money, and not taking help of any professional publishing house. We have managed to keep access to the journal free and we will keep it so in future too. A rising readership of the journal is reward enough for us. Our new year resolution is to try and make the journal even better and more useful to our readers.

Prior to invention of electronic fetal heart rate (FHR) monitors, intensive intermittent FHR auscultation was done. Electronic monitors made the process convenient. The principle underlying the process was that identification of changes in FHR helped diagnose fetal well being or its compromise early. This was expected to reduce fetal hypoxic morbidity and intrapartum deaths. In 1991 clinicians started questioning the usefulness of FHR monitoring in achieving the desired goals. There were debates and publications claiming it to be useful and not useful. Randomized controlled trials showed that intensive intermittent FHR auscultation acieved the same results as FHR monitoring. It was also shown that the latter increased rates of cesarean section and operative vaginal delivery. Though it reduced intrapartum fetal deaths, the incidence of cerebral palsy remained unchanged. It still continues to be used extensively because of its convenience and reduction in intrapartum fetal deaths and early onset neonatal convulsions. A drawback of electronic FHR monitors is that the false positive rate is quite high. Another drawback is possibility of a number of errors which can be due to machine malfunction or patient-related problems. A number of such errors have been described, and some of them cannot be overcome, except by adopting new technology. A number of such technologies are being evolved, such as the STAN monitor, the Monica AN24 monitor, the MindChild MERIDIAN monitor, and an FHR monitoring system based on radiofrequency technology. While such development is taking place, the older technology is by no means obsolete. Hence we have to live with the errors associated with it and try to circumvent those or eliminate them in newer models of the machines. It is interesting that newer errors are being reported even now. One such error is discussed in this issue of the journal. I hope it helps clinicians using electronic FHR monitors, and also the manufacturers who make the monitors.