Abstract
All guidelines regarding electronic fetal heart monitoring (EFM) before 2008 were designed to avoid more hypoxia than acidosis. In addition, the results of the Cochrane meta-analysis of 2013 do not show a significant improvement in neonatal outcomes using EFM or intermittent auscultation (IA). We retrospectively evaluated the results on delivery outcomes arising from a comparison between EFM and IA during labor of 2 specific and high-quality trials. We hypothesized that revisiting the delivery outcomes through the adoption of the recent National Institute of Child Health and Human Development (NICHHD) guidelines, the reported delivery outcomes would be different. The study retrospectively evaluated the results on delivery outcomes arising from the comparison between EFM and IA during labor of the "Dublin trial" and "Vintzileos trial" published, respectively, in 1985 and 1993. A translational model was constructed to recalculate these results, applying a correction factor to estimate the number of pathological patterns using the NICHHD guidelines for EFM. After the reevaluation of the 2 trials using the proposed correction factor, the comparison of the recalculated cesarean section and operative delivery rates for fetal distress between EFM and IA group were no longer statistically significant, both in the Dublin trial and Vintzileos trial. Even the comparison of the recalculated incidence of the rate of non-reassuring fetal heart rate (FHR) patterns in the EFM and IA groups has not given any indication of significance for the Vintzileos trial. Our results lead to reconsidering the results of the Dublin trial and Vintzileos trial in terms of operational rates of births, hypothesizing that these results would have been significantly lower if FHR traces were interpreted using the current NICHHD guidelines, which aim to identify potential acidotic fetuses rather than hypoxic ones.
Highlights
Electronic fetal monitoring (EFM) was introduced into clinical practice in the seventies and since it has become the most commonly used method for the surveillance of fetal well-being during labor
We retrospectively evaluated the results on delivery outcomes arising from a comparison between electronic fetal heart monitoring (EFM) and intermittent auscultation (IA) during labor of 2 specific and high-quality trials
Even the comparison of the recalculated incidence of the rate of non-reassuring fetal heart rate (FHR) patterns in the EFM and IA groups has not given any indication of significance for the Vintzileos trial
Summary
Electronic fetal monitoring (EFM) was introduced into clinical practice in the seventies and since it has become the most commonly used method for the surveillance of fetal well-being during labor. Since the first EFM classification of Boylan in 1987,1 the major international scientific societies have developed specific guidelines that, based on objective parameters, classify the EFM into risk categories with the goal of addressing obstetricians in order to act appropriately to reduce neonatal morbidity, and to avoid inappropriate cesarean section and operative delivery. The results of the Cochrane meta-analysis of 2013 do not show a significant improvement in neonatal outcomes using EFM or intermittent auscultation (IA)
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