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Historical perspectives: forgotten past, unpredictable future

C Sureau

    Bailliere'S Clinical Obstetrics and Gynaecology
    |June 1, 1996
    PubMed
    Summary
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    Electronic fetal monitoring (EFM) has mixed results, showing benefits in preventing fetal death but not improving long-term infant health and increasing C-sections. Clinical monitoring may offer similar outcomes without the drawbacks of EFM.

    Area of Science:

    • Obstetrics and Gynecology
    • Perinatal Medicine
    • Fetal Monitoring

    Background:

    • Intrapartum surveillance methods, including auscultation and electronic fetal monitoring (EFM), have evolved significantly.
    • The widespread adoption of EFM was driven by the goal of reducing perinatal mortality and detecting fetal distress.
    • Debate now surrounds the true benefits and drawbacks of EFM in contemporary obstetric practice.

    Observation:

    • While EFM is acknowledged to reduce perinatal mortality, its impact on long-term neonatal morbidity is questionable.
    • Studies indicate a notable increase in cesarean section rates associated with EFM use.
    • Comparative research suggests that traditional auscultation may yield comparable results to EFM regarding fetal mortality and infant morbidity.

    Findings:

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  • The effectiveness of EFM in improving long-term infant health outcomes remains uncertain.
  • EFM is linked to an increased rate of cesarean deliveries.
  • Clinical monitoring via auscultation appears to be as effective as EFM in certain critical outcomes.

    • Implications:

    • Current obstetric policy faces a choice between reverting to auscultation or refining EFM to identify more specific indicators of fetal compromise.
    • Developing more precise indicators for fetal asphyxia and cerebral palsy risk is crucial for optimizing cesarean section indications.
    • While EFM has fulfilled its promise of preventing fetal death, continuous clinical monitoring may offer similar benefits with potentially fewer adverse effects.