April 30, 2012 by Rebecca Dekker, PhD, RN, APRN
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**For an updated article on continuous electronic fetal monitoring, please view this article instead, “Evidence-Based Fetal Monitoring”

Healthcare providers in hospital birth settings often recommend continuous electronic fetal monitoring. In recent years, a wireless (mobile or telemetry) continuous fetal monitoring unit has come on the market. This has led providers telling women that they can wear the wireless monitor– and because the women are mobile– it is called “intermittent” monitoring. However, in reality, this is still continuous monitoring. So that leads us to the question…

Question: Is continuous electronic fetal monitoring necessary?

Answer: No. Intermittent auscultation with a handheld Doppler or fetoscope is safe and results in fewer C-sections and instrumental vaginal deliveries when compared with continuous electronic fetal monitoring.

Evidence: In a Cochrane review, researchers compiled the results of 12 randomized, controlled trials with more than 37,000 women. Women randomized to receive continuous electronic fetal monitoring had a higher rate of C-sections and instrumental vaginal deliveries when compared to women who were randomized to intermittent auscultation. There were no differences in perinatal mortality or cerebral palsy between the two groups. These findings were consistent in both low-risk and high-risk women. There was a lower risk of neonatal seizures in the continuous electronic fetal monitoring group; however, seizure events were very rare (1 out of 500).1

The evidence against continuous electronic fetal monitoring is so clear that the U.S. Preventive Services Task Force issued a recommendation saying that continuous electronic fetal monitoring should NOT be used in low risk women. Even ACOG (American Congress of Obstetricians and Gynecologists) has endorsed intermittent auscultation as an appropriate and safe alternative to electronic fetal monitoring.

1.   Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane database of systematic reviews. 2006(3):CD006066.

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