Q&A

Admission electronic fetal monitoring does not improve neonatal outcomes

J Fam Pract. 2003 June;52(6):431-454
By
Charles Cole, MD
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  • BACKGROUND: No studies have been able to demonstrate that routine electronic fetal monitoring decreases fetal birth asphyxia or its attending complications, such as cerebral palsy. Electronic fetal monitoring is still, however, the main mode of monitoring labors thought to be at high risk of intrapartum asphyxia. Admission electronic fetal monitoring has been used as an attempt to identify high-risk labors that might benefit from continuous electronic fetal monitoring during labor.
  • POPULATION STUDIED: Women were eligible for inclusion if they were admitted in labor and would not have otherwise undergone routine continuous electronic fetal monitoring. Inclusion criteria were singleton gestation <42 weeks, no concern for antenatal fetal compromise, no adverse obstetrical history, clear amniotic fluid, and no maternal fever.
  • STUDY DESIGN AND VALIDITY: Immediately after early amniotomy on diagnosis of labor, 8628 eligible women were randomized to receive either 20 minutes of external fetal monitoring or usual care (intermittent auscultation only). If the admission monitoring showed a baseline heart rate of 110 to 160 beats/min, acceptable variability, no decelerations, and more than 1 acceleration, intervention group patients received intermittent auscultation. If these criteria were not met, then electronic fetal monitoring was continued until delivery.
  • OUTCOMES MEASURED: The primary outcomes measured were neonatal mortality in the absence of a major congenital malformation or moderate-to-severe morbidity (admission of an infant to the neonatal intensive care unit with cord-blood metabolic acidosis, neonatal seizures, hypotonia lasting >4 hours, mechanical ventilation >15 minutes, use of inotropic support, renal failure, or meconium aspiration syndrome).
  • RESULTS: There was no difference in the primary outcome of neonatal morbidity and mortality between the intervention and usual-care groups (1.30% vs 1.28%). There were no differences in the groups for any of the neonatal secondary outcomes.
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PRACTICE RECOMMENDATIONS

Admission electronic fetal monitoring did not decrease neonatal morbidity and mortality compared with intermittent auscultation.

Patients in the admission fetal monitoring group were more likely to receive continuous electronic monitoring and fetal blood sampling, but there were no significant differences in the rates of operative deliveries or episiotomy. Institutions not routinely using admission electronic fetal monitoring should not start; those that do may not be benefiting their patients.

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