TY - JOUR
T1 - A Prospective Comparison of Selective and Universal Electronic Fetal Monitoring in 34,995 Pregnancies
AU - Leveno, K. J.
AU - Cunningham, F. G.
AU - Nelson, S.
AU - Roark, M.
AU - Williams, M. L.
AU - Guzick, D.
AU - Dowling, S.
AU - Rosenfeld, C. R.
AU - Buckley, A.
PY - 1986/9/4
Y1 - 1986/9/4
N2 - We investigated the effects of using intrapartum electronic fetal monitoring in all pregnancies, as compared with using it only in cases in which the fetus is judged to be at high risk. Predominant risk factors included oxytocin stimulation of labor, dysfunctional labor, abnormal fetal heart rate, or meconium-stained amniotic fluid. This prospective alternate-month clinical trial took place over a 36-month period during which 34,995 women gave birth. In alternate months, either 7 (for “selective monitoring”) or 19 (for “universal monitoring”) fetal monitors were made available in the labor and delivery unit. During the “selective” months, 6420 of 17,409 women (37 percent) were electronically monitored, as compared with 13,956 of 17,586 women (79 percent) during the “universal months.” Universal monitoring was associated with a small but significant increase in the incidence of delivery by cesarean section because of fetal distress, but perinatal outcomes as assessed by intrapartum stillbirths, low Apgar scores, a need for assisted ventilation of the newborn, admission to the intensive care nursery, or neonatal seizures were not significantly different. We conclude that not all pregnancies, and particularly not those considered at low risk of perinatal complications, need continuous electronic fetal monitoring during labor. (N Engl J Med 1986; 315:615–9.), Continuous intrapartum electronic monitoring of the fetal heart rate is considered by many clinicians to be superior to intermittent auscultation. The principal benefit claimed for continuous surveillance is earlier detection of fetal distress, which can reduce the frequency and severity of perinatal asphyxia. When electronic fetal monitoring was first introduced into clinical practice, it was typically reserved for use in pregnancies with complications.1 More recently, the use of such continuous monitoring during labor has been advocated for all pregnancies, including those at low risk for perinatal complications.2 , 3 Indeed, in 1978 it was estimated that at least two thirds of pregnancies…
AB - We investigated the effects of using intrapartum electronic fetal monitoring in all pregnancies, as compared with using it only in cases in which the fetus is judged to be at high risk. Predominant risk factors included oxytocin stimulation of labor, dysfunctional labor, abnormal fetal heart rate, or meconium-stained amniotic fluid. This prospective alternate-month clinical trial took place over a 36-month period during which 34,995 women gave birth. In alternate months, either 7 (for “selective monitoring”) or 19 (for “universal monitoring”) fetal monitors were made available in the labor and delivery unit. During the “selective” months, 6420 of 17,409 women (37 percent) were electronically monitored, as compared with 13,956 of 17,586 women (79 percent) during the “universal months.” Universal monitoring was associated with a small but significant increase in the incidence of delivery by cesarean section because of fetal distress, but perinatal outcomes as assessed by intrapartum stillbirths, low Apgar scores, a need for assisted ventilation of the newborn, admission to the intensive care nursery, or neonatal seizures were not significantly different. We conclude that not all pregnancies, and particularly not those considered at low risk of perinatal complications, need continuous electronic fetal monitoring during labor. (N Engl J Med 1986; 315:615–9.), Continuous intrapartum electronic monitoring of the fetal heart rate is considered by many clinicians to be superior to intermittent auscultation. The principal benefit claimed for continuous surveillance is earlier detection of fetal distress, which can reduce the frequency and severity of perinatal asphyxia. When electronic fetal monitoring was first introduced into clinical practice, it was typically reserved for use in pregnancies with complications.1 More recently, the use of such continuous monitoring during labor has been advocated for all pregnancies, including those at low risk for perinatal complications.2 , 3 Indeed, in 1978 it was estimated that at least two thirds of pregnancies…
UR - http://www.scopus.com/inward/record.url?scp=0022500398&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0022500398&partnerID=8YFLogxK
U2 - 10.1056/NEJM198609043151004
DO - 10.1056/NEJM198609043151004
M3 - Article
C2 - 3736600
AN - SCOPUS:0022500398
SN - 0028-4793
VL - 315
SP - 615
EP - 619
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 10
ER -