EFM reduces death from fetal hypoxia
A 1995 meta-analysis, including 9 of the Cochrane review studies with a total of 18,561 women, evaluated the additional outcome of death resulting from fetal hypoxia.3 Compared with IA, EFM was associated with a 59% reduction in death from fetal hypoxia (RR=0.41; 95% CI, 0.17-0.98). Continuous EFM prevented 1 perinatal death per 1000 births. The reduction in perinatal mortality was offset by a 53% increase in cesarean deliveries and a 23% increase in operative vaginal deliveries.3
Recommendations
The American College of Obstetricians and Gynecologists (ACOG) doesn’t recommend for or against continuous fetal heart rate monitoring in uncomplicated labor, recognizing either EFM or IA as acceptable in uncomplicated patients.4 ACOG does recommend continuous EFM for women with high-risk conditions (suspected fetal growth restriction, preeclampsia, and type 1 diabetes mellitus).
The US Preventive Services Task Force doesn’t support routine intrapartum EFM for low-risk woman. The Task Force found insufficient evidence for using EFM in high-risk pregnancies.5
The Royal College of Obstetricians and Gynaecologists and the Royal Australian and New Zealand College of Obstetricians and Gynecologists both recommend continuous EFM for high-risk women and IA for low-risk patients.6,7
Acknowledgements
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department or the US Army at large.