Central Fetal Monitoring: Effect on Perinatal Outcomes and Cesarean Section Rate

Abstract

Continuous electronic fetal heart monitoring during labor is routine in the United States—it presently is used in more than 85% of births. Nevertheless, benefit has not been unequivocally demonstrated, and some practitioners believe that the procedure may in fact increase the rate of operative delivery for fetal stress. Today many hospitals are incorporating central fetal monitoring into their labor and delivery suites. This retrospective study was planned to show whether central fetal monitoring influences neonatal outcomes and cesarean section rates. Central monitoring was utilized in 3512 deliveries and was not used in 3007 others. Outcome measures included the rate of cesarean section, 5-minute Apgar scores less than 7, and admission to the neonatal intensive care unit (NICU). The two groups of parturients were well matched for maternal age, body mass index, and birth weight at delivery. The only significant demographic difference between the groups was that there were 5% more white gravidas in the central monitoring group than in the group that was not monitored centrally. The cesarean section rate was the same with and without central fetal monitoring in term deliveries (13.4% and 14.5%, respectively) and in preterm deliveries (21.3% each). Similarly, there were no significant differences in the number of low Apgar scores (<7 at 5 minutes) in either term or preterm deliveries with and without central fetal monitoring. Finally, there was no difference in the rate of admission to the NICU for either term or preterm deliveries related to whether or not central fetal monitoring was carried out. Comparable results were obtained for all three outcomes when the data for term and preterm deliveries were pooled. Central fetal monitoring did not prevent perinatal morbidity in either term or preterm births in this retrospective survey. Because the procedure is very costly both to set up and to maintain, the apparent lack of benefit raises the question of whether available health care resources should be allocated for this purpose.