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Ingemar Ingemarsson born 1939 died 13 July 2013

Scandinavian leader of fetal monitoring

19-May-2014

Ingemar Ingemarsson from Lund was one of the first obstetricians to evaluate the new technology of fetal heart rate and uterine contraction monitoring in labour. Hewlett Packard had introduced the first commercial monitor in 1968 and, although soon widespread, it was used very badly. Over 30 years Ingemarsson did more than anyone to raise standards in fetal heart pattern interpretation in Scandinavia and worldwide.

Born in the town Nöttja in the Småland region, Ingemarsson later claimed that the local midwife had induced his labour by administering ergot-tainted wheat to his mother. After qualifying from Lund university in 197?, he initially wanted to be a surgeon. By the time his PhD was awarded in 1975, his dissertation which had begun as a study of the effect of terbutaline on the bile duct, had become a study of it as a tocolytic, and Ingemarsson had turned to obstetrics. He was ahead of his time, not only the first consultant in Sweden allocated specifically to the delivery ward, but in writing up a randomised trial, on terbutaline as a tocolytic, three years before Archie Cochrane awarded the wooden spoon to obstetrics for poor use of this research design! His name appeared on another half dozen randomised trials over the rest of his career but he was never really a triallist. Beloved by midwives for his non-interventionist approach, his forte was interpretation and teaching. He ran hundreds of meeting, in Scandinavia, the UK and Singapore where he worked as visiting professor in the 1980s.

As his research interest moved from tocolysis to fetal monitoring, and his colleague Mats Akerlund developed improved tocolytics, most notably the oxytocin antagonist atosiban, Ingemarsson embraced that work enthusiastically. However his healthy scepticism made him keep his distance from the Lund fetal ecg studies. Outsiders must have been surprised when his name was not on the 2001 Lancet trial of the STAN monitor, but he was vindicated twelve years and three enquiries later, when, his warnings heeded, the data had to be corrected!

He will be remembered for his magnum opus Fetal heart rate monitoring: a practical guide, co-written with his second wife Eva another obstetrician, which went into multiple Swedish editions and was translated into many languages.
Ingemarsson I. (1976)  Effect of terbutaline on premature labor. A double-blind placebo-controlled study. Am J Obstet Gynecol. 125: 520-4.

Ingemarsson I, Westgren M. (2007) ST analysis. BJOG; 114: 1445.

Amer-Wåhlin I, Hellsten C, Norén H, et al. Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial. Lancet 2001; 358: 534-538

Lund University Investigation of research misconduct - fetal monitoring technology STAN.
http://www.med.lu.se/nyheter/utredning_av_forskningsoredlighet
Accessed 18 September 2013

Jim Thornton

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Commentaries by Editor Prof. Jim Thornton