Electronic fetal monitoring: a brief summary of its development, problems and prospects

Electronic fetal monitoring (EFM) was introduced into clinical practice 30 years ago and spread very rapidly in most developed countries. The early optimism that EFM would lead to a marked reduction in fetal neurological injury has not been realized; however, it is now recognized that most such damage is unrelated to perinatal events. Clinical trials have shown that although EFM does reduce the incidence of intrapartum asphyxia, its use is also associated with an increase in cesarean sections. Abnormal fetal heart rate (FHR) patterns are poor predictors of fetal depression at birth when used without additional confirmatory information. An additional problem has been inconsistency in the interpretation of EFM tracings even among experts. This has reduced the clinical effectiveness of EFM and has also contributed to an increase in litigation in cases with adverse neonatal outcomes. Despite these shortcomings EFM continues to be used extensively on most obstetrical services, suggesting that obstetrical physicians and nurses find the technique helpful and will continue to use it until a better alternative comes along. The combination of relevant clinical data with EFM by means of intelligen computer systems may improve both the consistency and predictive value of intrapartum fetal assessment in the future.