Objectives To use a meta-analysis of all published random-lized trials to determine whether the use of continuous electronic fetal heart rate monitoring (EFM) as the main method of intrapartum fetal surveillance is associated with improved pregnancy outcome compared to intermittent aus-cultation.
Data Sources We used the MEDLINE data base and reference lists of articles to identify all published random-lized trials of EFM versus intermittent auscultation.
Methods of Study Selection A total of nine randomized trials published in peer-review journals were identified. The selection criterion was the use of EFM or intermittent auscultation as the main intrapartum fetal sureillance technique.
Data Extraction and Synthesis A total of 18,561 patients were included in the nine published randomized trails, 9398 in the EFM group and 9163 in the auscultation group. Measures of pregnancy outcome included cesarean delivery, cesarean for suspected fetal distress, overall use of forceps or vacuum, use of forceps or vacuum for suspected fetal distress, overall perinatal mortality, and perinatal mortality due to fetal hypoxia (intrapartum or early neonatal death) attributable to the method of intrapartum monitored electronically had a significantly higher overall cesarean rate (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.17–2.01), higher cesarean rate for fetal distress (OR 2.55, 95% CI 1.81–3.53), overall increased use of forceps or vacuum (OR 1.23, 95% CI 1.02–1.49), increased use of forceps or vacuum for suspected fetal distress (OR 2.50, 95% CI 1.97–3.18), and decreased perinatal mortality due to fetal hypoxia (OR 0.41, 95% CI 0.17–0.98).
Conclusion Electronic fetal monitoring is associated with increased rates of surgical intervention and decreased perinatal mortality due to fetal hypoxia.
Reprints are not available.
© 1995 The American College of Obstetricians and Gynecologists