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Intrapartum Fetal Surveillance. Is It Worthwhile?
1Department of Obetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada.
Obstetrics and Gynecology Clinics of North America
|January 5, 2000
Summary
Intrapartum fetal asphyxia, though rare, has serious consequences. Electronic fetal monitoring (EFM) is used for screening, but its benefits are unproven and may lead to unnecessary interventions.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Fetal Monitoring
Background:
- Intrapartum fetal asphyxia affects 3-4 per 1000 births, with severe cases leading to brain damage in at least 1 per 1000 births.
- Electronic fetal monitoring (EFM) is the primary screening tool for intrapartum fetal asphyxia due to limitations of clinical risk factors.
- Despite extensive use, the benefits of EFM as a screening test remain unestablished, raising ethical concerns about potential harm from unnecessary interventions.
Purpose of the Study:
- To evaluate the effectiveness of EFM in predicting and preventing intrapartum fetal asphyxia.
- To address the challenges in interpreting EFM patterns and the high rate of false-positive results.
- To explore the need for supplementary diagnostic tests to confirm fetal asphyxia and avoid overtreatment.
Main Methods:
- Review of clinical experience and existing clinical trials on EFM for intrapartum fetal asphyxia.
- Analysis of factors complicating EFM effectiveness, including lack of consensus on protocols and interpretation standards.
- Examination of criteria for identifying potential fetal asphyxia from fetal heart rate patterns.
Main Results:
- EFM benefits as a screening test for intrapartum fetal asphyxia are not definitively established.
- A significant proportion of EFM patterns are false-positive (approximately 90%), leading to potential unnecessary interventions.
- Accurate interpretation of EFM requires consistent scoring and is complicated by factors like poor record quality and pre-labor asphyxia.
Conclusions:
- The predictive value of EFM for intrapartum fetal asphyxia is limited, and its routine use may cause harm.
- There is a critical need for validated supplementary tests, such as fetal blood gas and acid-base assessment, to confirm diagnoses and prevent unnecessary interventions.
- Further research is required to establish clear protocols and improve the accuracy of EFM in identifying true cases of fetal asphyxia before fetal decompensation occurs.