Electronic Fetal Monitoring to Prevent Fetal Brain Injury: A Ubiquitous Yet Flawed Tool

Abstract

(JAMA. 2019;322:611–612) The practice of fetal cardiac rate monitoring began in the 1830s or earlier, and guidelines for intermittent auscultation came out in the 1920s and remained largely unchanged until the 1970s, when continuous electronic fetal monitoring (EFM) appeared. EFM generates a visual recording of fetal heart rate using either Doppler wave technology or a contact electrode on the fetal scalp. Fetal acidosis is associated with abnormal heart rhythms, including tachycardia, bradycardia and transient decreases in pulse rate, as well as diminished variability. Variability cannot practically be detected with auscultation.