Electronic fetal monitoringBMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7300.1436 (Published 16 June 2001) Cite this as: BMJ 2001;322:1436
Is not necessary for low risk labours
- Ros Goddard, specialist registrar in obstetrics and gynaecology (firstname.lastname@example.org)
- Royal United Hospital, Bath BA1 3NG
Papers p 1457
Electronic fetal monitoring with the cardiotocograph is standard practice during labour in most obstetric units in the United Kingdom. The technique was introduced as a screening test in the 1970s in the belief that it would improve the detection of fetal hypoxaemia and reduce cerebral palsy and perinatal mortality, particularly in high risk pregnancies. Early retrospective observational studies supported the view that it was superior to intermittent auscultation using either a Pinard stethoscope or a hand held doppler ultrasound device.1 Its use spread rapidly from high risk to low risk pregnancies where the fetus is at least risk from hypoxic events in labour. Was this spread necessary or wise?
By the 1990s systematic reviews of randomised controlled trials of electronic fetal monitoring versus intermittent auscultation during labour had shown no effect on neonatal outcomes such as metabolic acidosis at birth, low Apgar scores or admissions to neonatal intensive care.2–4 An increase in neonatal seizures was seen in the group with intermittent auscultation but no long term increase in neurological problems.5
Electronic fetal monitoring did, however, …