Standard Labor Practice Questioned

A standard test given to pregnant women when they go into the hospital to deliver may not be worth the effort, suggest Irish investigators.

Their study in 2003 issue of The Lancet finds routine use of electronic fetal monitoring is no better at identifying babies who may be at risk of neurological problems due to oxygen starvation during childbirth as routine monitoring with a stethoscope.

EFM gained widespread popularity in labor and delivery units more than 20 years ago, when doctors believed it provided a better way to monitor the fetal heart rate. The practice is generally administered during the first 20 minutes of admission to the labor room, regardless of whether a woman is considered at risk for premature birth or other labor problems. Studies, however, have shown EFM does little to reduce the incidence of birth problems related to asphyxia, such as cerebral palsy, and may even be increasing the need for Caesarean birth.

This study compared the use of routine EFM on admission to the labor room with standard care using a stethoscope. Nearly 8,600 women considered at low risk for complications were randomly assigned one of the interventions. Results showed no difference in neonatal outcomes between the two groups, leading the authors to conclude that routine use of EFM does not reduce morbidity or mortality among newborns.

Contrary to previous studies, however, EFM in this study did not lead to additional need for Cesarean section or other operative measures during birth.

Still, the authors believe their findings suggest use of EFM during the first 20 minutes of admission cannot be justified in women at low risk for neonatal complications.

SOURCE: The Lancet, 2003;361:465-470