OBJECTIVE The high false-positive rate of electronic fetal heart rate monitoring is the major obstacle to the correct prediction and diagnosis of intrapartum fetal distress. Fetal pulse oximetry is a safe and accurate indicator of fetal oxygenation. The aim of this study was to evaluate the clinical use of this technique for the diagnosis of fetal hypoxia and for prevention of fetal metabolic acidosis and asphyxia during labour, in the presence of meconium-stained amniotic fluid with or without abnormal fetal heart rate patterns, using a threshold value of 30% oxygen saturation. METHODS Fetal blood oxygen saturation levels (SpO2) of 58 term fetuses with non-reassuring fetal status were measured during labour by fetal pulse oximetry. In 35 cases the amniotic fluid was stained with meconium at onset of labour. Mean SpO2 levels at the different stages of labour were matched against fetal heart rate patterns, the amniotic fluid status, and neonatal outcome. The 35 cases with meconium-stained amniotic fluid were compared with a control group of 28 pregnant women at term who had meconium-stained amniotic fluid during labour but were not monitored by pulse oximetry. RESULTS When the fetal heart rate tracings were abnormal, mean SpO2values were significantly lower in the first 30 minutes of application and in the last 30 minutes of labour or before Cesarean section. Meconium-stained amniotic fluid was associated with lower SpO2values only when fetal heart monitoring showed a "non-reassuring" pattern. No cases were observed with severe neonatal acidosis, with Apgar score <7 at 5 minutes, or with other adverse neonatal events. In patients with meconium-stained amniotic fluid, neonatal outcomes were better in the group monitored by pulse oximetry versus the control group, although the differences were not statistically significant. CONCLUSIONS Continued monitoring of fetal oxygen saturation combined with fetal heart rate monitoring may improve accuracy in the evaluation of fetal well-being. As a result, labour could be more safely managed in pregnancies with non-reassuring fetal status as measured by conventional methods, especially in the presence of meconium-stained amniotic fluid.