  Background: Studies about the feasibility of monitoring fetal
electroencephalogram (fEEG) during labor began in the early 1940s. By the
1970s, clear diagnostic and prognostic benefits from intrapartum fEEG
monitoring were reported, but until today, this monitoring technology has
remained a curiosity.
  Objectives: Our goal was to review the studies reporting the use of fEEG
including the insights from interpreting fEEG patterns in response to uterine
contractions during labor. We also used the most relevant information gathered
from clinical studies to provide recommendations for enrollment in the unique
environment of a labor and delivery unit.
  Data sources: PubMed.
  Eligibility criteria: The search strategy was: ("fetus"[MeSH Terms] OR
"fetus"[All Fields] OR "fetal"[All Fields]) AND ("electroencephalography"[MeSH
Terms] OR "electroencephalography"[All Fields] OR "eeg"[All Fields]) AND
(Clinical Trial[ptyp] AND "humans"[MeSH Terms]). Because the landscape of fEEG
research has been international, we included studies in English, French,
German, and Russian.
  Results: From 256 screened studies, 40 studies were ultimately included in
the qualitative analysis. We summarize and report features of fEEG which
clearly show its potential to act as a direct biomarker of fetal brain health
during delivery, ancillary to fetal heart rate monitoring. However, clinical
prospective studies are needed to further establish the utility of fEEG
monitoring intrapartum. We identified clinical study designs likely to succeed
in bringing this intrapartum monitoring modality to the bedside.
  Limitations: Despite 80 years of studies in clinical cohorts and animal
models, the field of research on intrapartum fEEG is still nascent and shows
great promise to augment the currently practiced electronic fetal monitoring.
