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Intrapartum Fetal Monitoring

CAHILL, ALISON G. MD, MSCI; SPAIN, JANINE MD

Clinical Obstetrics and Gynecology: June 2015 - Volume 58 - Issue 2 - p 263–268
doi: 10.1097/GRF.0000000000000109
Prevention of Cesarean Delivery

Intrapartum fetal monitoring to assess fetal well-being during the labor and delivery process has been a central component of intrapartum care for decades. Today, electronic fetal monitoring (EFM) is the most common method used to assess the fetus during labor without substantial evidence to suggest a benefit. A Cochrane review of 13 trials, which included over 37,000 women, found that continuous EFM provided no significant improvement in perinatal death rate [risk ratio (RR) 0.86; 95% confidence interval (CI), 0.59-1.23] or cerebral palsy rate (RR 1.75; 95% CI, 0.84-3.63) as compared with intermittent auscultation; however, there was a significant decrease in neonatal seizures (RR 0.50; 95% CI, 0.31-0.80). In addition, there was a significant increase in cesarean delivery (RR 1.63; 95% CI, 1.29-2.07) and operative vaginal delivery (RR 1.15; 95% CI, 1.01-1.33). Despite the lack of scientific support to suggest that EFM reduces adverse neonatal outcomes, its use is almost universal in the hospital setting and very likely has contributed to the rise in cesarean rate.

Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri

The authors declare that they have nothing to disclose.

Correspondence: Alison G. Cahill, MD, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, MSCI, St. Louis, MO. E-mail: cahilla@wudosis.wustl.edu

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