Title: Indicators for Fetal Hypoxia: a Review of the Clinical Evidence and Guidelines

is an information service for those involved in planning and providing health care in Canada. HTIS responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources and a summary of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. HTIS responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report. Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners' own terms and conditions. Asphyxia (hypoxia and metabolic acidosis) is a major cause of perinatal morbidity and can be responsible for neonatal mortality and cerebral palsy. 1,2 The general condition of newborns is graded by the Apgar score. The score, devised by Dr. Virginia Apgar, is based on appearance, pulse, grimace (reflex irritability), activity, and respiration. Each indicator is given a score from zero (absence), one, or two and added together. Scores totaling less than four are considered critically low, while those above seven are considered normal. 3 A low Apgar score has become a proxy for asphyxia. 4 While Apgar score can evaluate the health of a newborn baby, cardiotocography can be used for intrapartum fetal monitoring. 5 In this situation, an abnormal fetal heart rate pattern may signify asphyxia. 6 However, while cardiotocography provides a sensitive measure, it has low specificity so other indicators of fetal hypoxia and acidosis need to be used to improve …