The traditional discipline of obstetrics is undergoing a transformation and is being revitalized. While classical theories, such as Friedman’s labor curve, are being challenged by new evidence, innovative technologies, including artificial intelligence (AI), multi-omics, and minimally invasive fetal surgery, are increasingly being integrated into clinical diagnosis and treatment strategies. With the advancement of new evidence-based medicine and novel technologies, obstetric decision-making is shifting from an empirical approach to a precision-based one. The delivery room, as the core clinical area in obstetrics, involves rapid and uncertain changes in the patient’s condition driven by regular uterine contractions. Physicians and midwives must remain vigilant at all times and actively employ innovative methods to make timely, comprehensive, and anticipatory decisions guided by evidence-based medicine and clinical guidelines. Only through individualized and precise management of each patient can optimal maternal and neonatal outcomes be achieved. Induction of labor strategies and tachysystole Obstetrics seeks to answer two classic questions: first, “When” to deliver, and second, “How” to deliver. Pregnant women with various comorbidities and complications require timely termination of pregnancy at appropriate gestational ages to reduce adverse maternal and neonatal outcomes. If labor does not commence spontaneously, induction of labor is necessary. In recent years, for low-risk nulliparous women, the ARRIVE trial in the United States1 found that induction at 39 weeks, compared with expectant management, did not significantly increase perinatal death or severe neonatal morbidity (relative risk (RR) = 0.80, 95% confidence interval (CI): 0.64–1.00) and was associated with a lower cesarean section rate (RR = 0.84, 95% CI: 0.76–0.93). While the generalizability of these findings remains controversial globally, the high-quality clinical research and systematic reviews emerging in the field of induction warrant attention. In implementing induction protocols, the chosen method should be tailored to the cervical condition. Misoprostol is a synthetic prostaglandin analog with stable effects and low cost. When administered vaginally, it effectively induces uterine contractions and improves cervical conditions, making it a commonly used induction agent. Cervical balloon dilation involves placing a balloon in the cervical canal to mechanically dilate it, thereby stimulating the release of endogenous prostaglandins, softening the cervix, and inducing contractions. Recent evidence-based medicine indicates that, when performed correctly, cervical balloon placement does not increase adverse pregnancy outcomes and effectively promotes cervical ripening. The combination of misoprostol and a cervical balloon is emerging as a potentially effective novel strategy for cervical ripening. A systematic review2 comparing induction with misoprostol alone versus misoprostol combined with a cervical balloon found that mechanical cervical dilation combined with misoprostol may accelerate the labor process and improve neonatal outcomes without increasing maternal or neonatal complications. Furthermore, labor management essentially involves the management of uterine contractions. Although the American College of Obstetricians and Gynecologists guideline defines tachysystole as > 5 contractions in 10 minutes, the need for intervention should be determined by integrating the patient’s contraction intensity and fetal heart rate patterns, balancing the need to progress labor with the avoidance of events such as fetal distress and precipitous delivery. Intrapartum ultrasound for predicting labor progress The use of intrapartum ultrasound has increased markedly in recent years, primarily for assessing labor progression. Intrapartum ultrasound is more accurate than traditional digital vaginal examination in evaluating fetal head position and descent. Additionally, ultrasound offers advantages such as being less invasive and better tolerated. Repeated ultrasound assessments can reduce the risk of intrauterine infection associated with frequent vaginal examinations. Ultrasound can also evaluate other labor parameters, including fetal head posture, the angle of head rotation within the birth canal, and asynclitism. Precise assessment of these parameters and implementation of individualized interventions can optimize maternal and neonatal outcomes and effectively reduce cesarean section rates. One study3 introduced the “occiput-spine angle” (OSA), an intrapartum ultrasound parameter for quantitatively calculating the degree of fetal head flexion relative to the spine during the first stage of labor. In 108 term singleton pregnancies, the mean OSA was 126° ± 9.8°. The risk of obstetric intervention (cesarean section or forceps/vacuum-assisted delivery) was significantly higher in women with OSA 25 bpm lasting > 1 minute. It results from autonomic instability (primarily parasympathetic) and is associated with an increased risk of neonatal acidosis and NICU admission (approximately 2-fold risk). Persistence beyond 1 minute requires interventions to improve fetal oxygenation (e.g., reducing oxytocin, inhibiting contractions, stopping maternal pushing). If baseline elevation occurs without decelerations but with a ZigZag pattern, clinicians should be vigilant for fetal neuroinflammation associated with chorioamnionitis. The suggestive of fetal inflammation (SOFI) pattern involves a baseline FHR elevation > 10% without repetitive decelerations, suggesting fetal inflammation and association with adverse perinatal outcomes. The relative utero-placental insufficiency of labour (RUPI-L) pattern is characterized by a rising FHR baseline during labor with widespread, deep decelerations coinciding with regular contractions; the width and depth of decelerations decrease or disappear when contraction intensity and frequency diminish. The pathophysiology involves impaired placental function leading to reduced placental oxygen reserve, with regular contractions further diminishing fetal oxygen supply. Due to chronic exposure to subclinical hypoxia, there is chronic release of adrenal-derived catecholamines, and the FHR baseline is typically at the upper limit of the normal range during intervals between decelerations. In summary, the interpretation of intrapartum fetal heart rate monitoring should be based on the type of fetal hypoxia and the fetal response to hypoxic stress, considering the underlying pathophysiology rather than mechanically applying pattern definitions. Clinicians should shift their focus from solely recognizing deceleration patterns to also evaluating baseline stability and variability. Furthermore, one study10 pointed out that noninvasive fetal electrocardiography can provide objective, beat-to-beat analysis of fetal heart rate variability, overcoming inherent limitations of traditional CTG, such as subjectivity, high body mass index dependency, and the inability to capture true beat-to-beat signals. It has demonstrated unique advantages in remote home monitoring, management of obese pregnant women, assessment of fetal growth restriction, and evaluation of cardiac arrhythmias. Although signal loss remains a major technical challenge—particularly between 26 and 34 weeks of gestation due to interference from vernix caseosa—the integration of AI algorithmsholds promise for improving the sensitivity of early hypoxia detection. From the individualized selection of induction strategies and the objective assessment of labor progress via intrapartum ultrasound, to the deeper interpretation of fetal heart rate monitoring moving from pattern recognition toward understanding pathophysiology, all these aspects reflect the ongoing transition in obstetric decision-making from empirical judgment to precision intervention, driven by both evidence-based medicine and AI. With the continuous maturation of multimodal data fusion and deep learning models, obstetrics is poised to advance further into a new phase of intelligent and individualized care. Funding Supported by Noncommunicable Chronic Diseases-National Science and Technology Major Project (2024ZD0532100) and National High Level Hospital Clinical Research Funding (Youth Clinical Research Project of Peking University First Hospital) (2025YC14). Conflicts of Interest None. Data Availability Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. Editor Note Huixia Yang is one of the Editors-in-Chief of Maternal-Fetal Medicine. The article was subject to the journal’s standard procedures, with peer review handled independently of this editor and the associated research groups.
Feng et al. (2026) studied this question.