Intrapartum electronic fetal monitoring in low-risk women: A literature review

Women's care in labour is largely dominated by technological interventions and it has been argued that the use of Electronic Fetal Monitoring (EFM) in labour has benefited some women. Others have purported that its widespread introduction into clinical practice has not been based on best evidence. A review of the literature emphasises the fact that few good-quality studies have been carried out worldwide, and that these are dominated by clinical trials. Despite this approach, EFM has not met the outcomes it intended to achieve in respect of preventing perinatal mortality or morbidity, and a recent International Task Force report reinforces the fact that cerebral palsy is not solely confined to hypoxia in childbirth. The analysis of results has identified several issues that have a major impact on NHS care delivery in the UK. These include: trials failing to include their intervention criteria, flawed randomisation and comparisons between practice settings, a high frequency of non-reassuring patterns being a feature of normal labour, a false positive rate of 99.8% in predicting cerebral palsy, epidemiological factors showing most cases occur prior to labour, higher risk of Caesarean sections in those classed as low risk, and 74% of first pregnancies undergoing continuous EFM in the UK. In the professional context, these are particularly relevant since midwives have a statutory and professional obligation to put the interests of mothers and babies above all else. In terms of clinical governance, professionals are required to base their practice on best available evidence; clinical guidelines must be driven by research in order to rationalise the frequency and appropriate use of EFM in low-risk women.