Electronic Fetal Monitoring: Is It of Benefit?

Abstract

ABSTRACT: Electronic fetal monitoring (EFM) of the fetal heart rate during labor and delivery has become a cornerstone of the new technology of obstetrics. Its routine use has been advocated, and the majority of labors in the U.S. are now monitored electronically. Recently, questions have been raised about the benefits of EFM. Review of the literature shows that only 4 randomized controlled clinical trials (RCTs) of EFM have been carried out. These show little if any benefit from the use of EFM in comparison to monitoring by stethoscope (fetoscope). The lack of diagnostic precision of EFM is reflected in high false positive and false negative rates of identification of fetuses in distress. Although many retrospective studies of EFM attempt to correlate use of EFM with declines in perinatal mortality in specific hospitals, the 4 RCTs showed no difference in mortality between babies monitored by auscultation and those who were electronically monitored. No differences have been found in morbidity, including neurologic status, between infants in the two groups. Electronic fetal monitoring has been associated with a significant increase in the cesarean section rate in most retrospective studies and all the RCTs.