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Electronic Fetal Monitoring in the United States: Temporal Trends and Adverse Perinatal Outcomes

Ananth, Cande V. PhD, MPH; Chauhan, Suneet P. MD; Chen, Han-Yang MS; D’Alton, Mary E. MD; Vintzileos, Anthony M. MD

doi: 10.1097/AOG.0b013e318289510d
Original Research

OBJECTIVE: To examine trends in electronic fetal monitoring (EFM) use and quantify the extent to which such trends are associated with changes in rates of primary cesarean delivery and neonatal morbidity and mortality.

METHODS: We carried out a retrospective study of more than 55 million nonanomalous singleton live births (24–44 weeks of gestation) delivered in the United States between 1990 and 2004. Changes in the risks of neonatal mortality, cesarean delivery, and operative vaginal delivery for fetal distress, 5-minute Apgar score lower than 4, and neonatal seizures (at 34 weeks of gestation or after) were examined in relation to changes in EFM use.

RESULTS: Electronic fetal monitoring use increased from 73.4% in 1990 to 85.7% in 2004, a relative increase of 17% (95% confidence interval 16–18%). This increase was associated with an additional 5% and 2% decline in early and late neonatal deaths, respectively, at 24–33 weeks of gestation as well as a 4–7% additional decline in the 5-minute Apgar score lower than 4 at 24–33, 34–36, and 37–44 weeks of gestation. Increasing EFM use was associated with a 2–4% incremental increased rate of both cesarean delivery and operative vaginal delivery for fetal distress at 24–33, 34–36, and 37–44 weeks of gestation. Increasing EFM was not associated with any temporal changes in the rate of neonatal seizures.

CONCLUSIONS: The temporal increase in EFM use in the United States appears to be modestly associated with the recent declines in neonatal mortality, especially at preterm gestations.

LEVEL OF EVIDENCE: II

The increasing use of electronic fetal monitoring in the United States is associated with temporal declines in neonatal morbidity and mortality.

Department of Obstetrics and Gynecology, College of Physicians and Surgeons, and the Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York; the Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia; the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; and the Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York.

Corresponding author: Cande V. Ananth, PhD, MPH, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University Medical Center, 622 West 168th Street, New York, NY; e-mail: cande.ananth@columbia.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented, in part, at the 32nd annual meeting of the Society for Maternal-Fetal Medicine, February 6–11, 2012, Dallas, Texas.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.