Fetal monitoring data in 200 consecutive cases was evaluated in the 2nd h prior to delivery to determine how neonatal outcome could be most accurately predicted. The correlation between ominous fetal heart rate-uterine contraction (FHR-UC) patterns and a depressed Apgar score at 1 min was, at best, 37%. Where the last fetal scalp blood pH (FSB-pH) was .ltoreq. 7.2, neonatal depression occurred in 88% of cases. FSB-pH may provide a more reliable means of diagnosing fetal distress.