Changing attitudes to exercise induced asthma.

on scalp blood, such as measurement of lactate concentration, do not appear to improve diagnostic accuracy. Results of direct intrapartum monitoring of the neurological state of the fetus by electroencephalogram recordings'8 19 are difficult to interpret and once again probably identify only severe fetal distress. Against a background of slow technical progress there has been an increasing demand for more "natural" labour. Mothers often accept fetal monitoring,20 especially when they have had previous obstetric problems. Radiotelemetry2l allows more mobility and although this may not confer any great obstetric advantage,22 it should make fetal heart rate monitoring more acceptable and it is surprising that it has not had a more enthusiastic reception. There is not, and is never likely to be, a single simple test of fetal wellbeing in labour. It is impossible to predict with sufficient accuracy which fetuses will become distressed, and probably all labours should be monitored. At present this entails fetal heart rate recording and scalp blood analysis, for the evidence suggests that if continuous monitoring of the fetal heart rate is used scalp blood analysis is an essential adjunct. Far more attention should be given to analysis of fetal heart rate traces by computer, since if this is shown to be beneficial inexpensive microprocessors could be used on a wide scale. It is high time that we had a new generation of smaller and more intelligent fetal heart rate monitors which, together with telemetry might make fetal monitoring in labour more effective and less intrusive. ROBERT S SAWERS