Rationale of fetal intrauterine resuscitation during labor

Cardiotocography is a non-invasive technique used for monitoring fetal heartbeat and uterine contractile activity. Fetal heart rate tracings are usually classified into a three-tiered system, in which there is a category II intermediate class with low probability of hypoxia and acidosis. Intrauterine resuscitation techniques are a series of promptly accessible interventions to promote fetal well-being. They are useful in case of a category II fetal heart rate tracing and in other selected cases. In case of fetal heart rate alterations, an individualized approach should always be adopted to tailor the intervention to the mother and the fetus. In this review, we analyze the pathophysiology of some frequently used intrauterine resuscitation techniques - tocolysis, maternal repositioning, and the administration of oxygen and intravenous fluids - to clarify their mechanisms of action and the clinical situations in which each one of them should be prioritized or should not be applied. Furthermore, we explore ongoing controversies over some intrauterine resuscitation techniques.