FHM

[DebSlater]

Anne

The NCT has produced an evidence-based briefing on Continuos EFM in labour.  I have a copy of the document in Word.



The "Key Points" of the briefing say:

"Routine continuous electronic fetal monitoring in labour was introduced into practice before its efficacy and safety could be demonstrated. Its only clinical benefit would now appear to be in the reduction of neonatal seizures, the long-term effects of which appear to be minimal. The increased risks are higher rates of caesarean and operative vaginal delivery.

The National Institute for Clinical Excellence (NICE) (2001) recommends that continuous electronic fetal monitoring be offered and recommended to women with high-risk pregnancies and where oxytocin is being used for induction or augmentation of labour. However, for women who are healthy and have an uncomplicated pregnancy, the NICE guideline states that intermittent auscultation should be offered and recommended in labour. It also notes that current evidence does not support the use of admission continuous electronic fetal monitoring in low risk pregnancies. A recent paper has reinforced the evidence on this (Mires et al, 2001)."

The references referred to in the briefing are:

Edington P, Sianda J, Beard RW. (1975) Influence on clinical practice of routine intrapartum fetal monitoring. British Medical Journal 3, 341-343.

Garcia J, Corry M, MacDonald D, Elbourne D, Grant A. (1985) Mother' views of continuous electronic fetal heart monitoring and intermittent auscultation in a randomized controlled trial. Birth 12(2) 79-85.

Leveno KJ, Cunningham FG, Nelson S et al (1986) A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies. The New England Journal of Medicine 315 Sep 615-619.

Mires G, Williams F, Howie P (2001) Randomised controlled trial of cardiotocography versus Doppler auscultation of the fetal heart at admission in labour in a low risk obstetric population. British Medical Journal 322; 1457-62.

National Institute for Clinical Excellence (2001) The use of electronic monitoring: The use and interpretation of cardiotocogrphy in intrapartum fetal surveillance. National Institute for Clinical Excellence.

Syndal SH. (1988) Responses of labouring women to fetal heart rate monitoring. A critical review of the literature. Journal of Nurse-Midwifery 33 (5) Sep 208-216

Thacker SB, Stroud DF. Continuous electronic heart rate monitoring for fetal assessment during labor (Cochrane Review). In: The Cochrane Library, Issue 4 2000. Oxford: Update Software.

Tew M. (1990) Safer Childbirth? A critical history of maternity care. London: Chapman and Hill."

For those National Institute of Clinical Excellence (NICE), for anyone who may not be aware is a body set up to review evidence in areas of health, and provide recommendations - thereby providing clinical excellence.  It is only been around for a few years.

Debbie Slater
Perth, WA