Constant Electronic Fetal Monitoring
(CEFM).
Listed below is a study
which examines the evidence for CEFM and most hospitals now make
it optional unless there is a good medical reason to keep an eye
on babies heart throughout your labour.
Efficacy and safety of
intrapartum electronic fetal monitoring: an update.
[Review] Obstetrics &
Gynecology. Thacker SB. Stroup DF. Peterson HB. 86(4 Pt 1):613-20,
1995 Oct.
Abstract
OBJECTIVE: To
compare the efficacy and safety of routine electronic fetal monitoring
(EFM) of labor with intermittent auscultation, using the results
of published randomized controlled trials (RCTs).
DATA SOURCES:
We identified RCTs by searching the MED-LINE data base for the period
1966-1994, contacting experts, and reviewing published references.
METHODS OF STUDY
SELECTION: Our search identified 12 published RCTs addressing
the efficacy and safety of EFM; no unpublished studies were found.
The studies included 58,855 pregnant women and their 59,324 infants
in both high- and low-risk pregnancies from ten clinical centers
in the United States, Europe, Australia, and Africa.
DATA EXTRACTION
AND SYNTHESIS: Data were abstracted, and their accuracy
was confirmed independently. A single reviewer assessed study quality
based on criteria developed by others for RCTs. Data reported from
similar studies were used to calculate a combined risk estimate
for each of nine outcomes. Overall, a statistically significant
decrease was associated with routine EFM for a 1-minute Apgar score
less than 4 (relative risk [RR] 0.82, 95% confidence interval [CI]
0.65-0.98) and neonatal seizures (RR 0.5, 95% CI 0.30-0.82). The
protective effect of EFM for a 1-minute Apgar score less than 4
was apparent only in the non-United States studies, and the protective
effect for neonatal seizures was evident only in studies with high-quality
scores. No significant differences were observed in 1-minute Apgar
scores less than 7, rate of admissions to neonatal intensive care
units, and perinatal death. An increase associated with the use
of EFM was observed in the rate of cesarean delivery (RR 1.33, 95%
CI 1.08-1.59) and total operative delivery (RR 1.23, 95% CI 1.15-1.31).
Risk of cesarean delivery was greatest in low-risk pregnancies.
CONCLUSION:
The only clinically significant benefit from the use of routine
EFM was in the reduction of neonatal seizures. Because of the increase
in cesarean and operative vaginal deliveries, the long-term benefit
of this reduction must be evaluated in the decision reached jointly
by the pregnant woman and her clinician to use EFM or intermittent
auscultation during labor.
The routine use of electronic
fetal heart monitoring (EFM) in American obstertrics is an unscientific
practice that increases cesarian section without improving outcomes.
The overuse of EFM must be challenged as iatrogenic.
I.e There is NO evidence to support the use
of EFM in Labour.
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