Birth-attendants monitoring labour need to discern fetal heart rate patterns. A novel hypothesis that ‘timing of decelerations is a red herring’ has strange attraction. Notwithstanding, this review uniquely highlights direct empirical evidence that hypoxaemic decelerations are late in timing and decelerations with early timing cannot be explained by hypoxaemic chemoreflex. Deceleration size/shape/area disregarding timing seem poor predictors of acidaemia. Recognising the majority non-hypoxaemic-reflex decelerations (early) allows focus/attention to potentially pathological ones. Fetuses tolerate limited degree/duration of hypoxaemia. Currently, there aren’t safe/reliable biomarkers of fetal decompensation. Therefore, persistent hypoxaemic (late) decelerations should be differentiated, ameliorated, additional tests performed or delivery expedited.

Letter to the Editor, BJOG Title:Deceleration Area and Deceleration Capacity: Poor predictors of fetal acidaemia in human labour! The strengths of visual versus computerised cardiotocography interpretation.Re: Georgieva A, Lear CA, Westgate JA, Kasai M, Miyagi E, Ikeda T, Gunn AJ, Bennet L. Deceleration area and capacity during labour-like umbilical cord occlusions identify evolving hypotension: a controlled study in fetal sheep. BJOG 2021; https://doi.org/10.1111/1471-0528.16638.Author: Mr. Shashikant L SHOLAPURKARMD, DNB, MRCOGDept of Obstetrics & Gynaecology,Royal United Hospital, Bath, BA1 3NG, UKEmail:[email protected]; [email protected]; Tel: 07906620662Short Running Title: Deceleration area and capacity in labourWord count: 500Corresponding Author: Mr. Shashikant L SHOLAPURKARMD, DNB, MRCOGDept of Obstetrics & Gynaecology,Royal United Hospital, Bath, BA1 3NG, UKStatement of interest: The author has no conflict of interest or funding to declare.

Letter to the Editor, BJOG

Letter to the Editor, BJOG Title:Prophylactic negative wound pressure dressing (NWPD) after caesarean – an extended debate to include surgical aspectsRe: Hyldig N, Joergensen JS, Lamont RF, Moller S, Vinter CA. Prophylactic negative pressure wound therapy in obese women undergoing caesarean section: a commentary on new evidence that fuels the debate. BJOG 2021; https://doi.org/10.1111/1471-0528.16750.Author: Mr. Shashikant L SHOLAPURKARMD, DNB, MRCOGDept of Obstetrics & Gynaecology,Royal United Hospital, Bath, BA1 3NG, UKEmail: [email protected]: 07906620662Word count: 500Corresponding Author: Mr. Shashikant L SHOLAPURKARMD, DNB, MRCOGDept of Obstetrics & Gynaecology,Royal United Hospital, Bath, BA1 3NG, UKStatement of interest: The author has no conflict of interest or funding to declare.

A document by Shashikant Sholapurkar. Click on the document to view its contents.

Letter to the Editor, BJOG Title:Deceleration Area and Deceleration Capacity: Promising predictors of fetal acidaemia in human labour? Visual versus computerised cardiotocographyRe: Georgieva A, Lear CA, Westgate JA, Kasai M, Miyagi E, Ikeda T, Gunn AJ, Bennet L. Deceleration area and capacity during labour-like umbilical cord occlusions identify evolving hypotension: a controlled study in fetal sheep. BJOG 2021; https://doi.org/10.1111/1471-0528.16638.Author: Mr. Shashikant L SHOLAPURKARMD, DNB, MRCOGDept of Obstetrics & Gynaecology,Royal United Hospital, Bath, BA1 3NG, UKEmail:[email protected]; [email protected]; Tel: 07906620662Short Running Title: Deceleration area and capacity in labourWord count: 500Corresponding Author: Mr. Shashikant L SHOLAPURKARMD, DNB, MRCOGDept of Obstetrics & Gynaecology,Royal United Hospital, Bath, BA1 3NG, UKStatement of interest: The author has no conflict of interest or funding to declare.

Letter to the Editor, BJOG Title: ESMiE confidential enquiry: Broader view besides focus on errors by birth-attendants.Re: Rowe R, Draper ES, Kenyon S, Bevan C, Dickens J, Forrester M, Scanlan R, Tuffnell D, Kurinczuk JJ. Intrapartum-related perinatal deaths in births planned in midwifery-led settings in Great Britain: findings and recommendations from the ESMiE confidential enquiry. BJOG 2020;127:1665–1675.Author: Mr. Shashikant L SHOLAPURKARMD, DNB, MRCOGDept of Obstetrics & Gynaecology,Royal United Hospital, Bath, BA1 3NG, UKShort running title: ESMiE enquiry: broader viewEmail: [email protected] Tel: 07906620662Word count: 500Corresponding Author: Mr. Shashikant L SHOLAPURKARMD, DNB, MRCOGDept of Obstetrics & Gynaecology,Royal United Hospital, Bath, BA1 3NG, UKStatement of interest: The author has no conflict of interest or funding to declare.

Continued instances of serious birth asphyxia following intermittent auscultation (IA) need not wholly imply inherent limitations. This review uses analytical modelling to establish a safer and improved regime. It demonstrates that the Doppler-device is superior to Pinard stethoscope, with observation of the numerical read-out of fetal heart rate (FHR) from the later part of contraction till the onset of next contraction. Current recommendation of actually counting heart tones for 1 minute has many fallacies. IA should focus on the baseline FHR and late decelerations. Detection of additional FHR changes like accelerations, overshoots or cycling is cumbersome and adds little value.