February 2004 · Vol. 16, No. 2Electronic fetal monitoring: The difficulty of linking patterns with outcomes
Nonreassuring tracings don’t always correlate with adverse outcomes, and vice versa. A look at what we know and don’t know from evidence to date.
Dr. Sorem is assistant clinical professor of obstetrics and gynecology, Stanford University School of Medicine, Stanford, Calif. Dr. Druzin is chief, division of maternal-fetal medicine, Stanford University Medical Center, and professor of obstetrics and gynecology, Stanford University School of Medicine, Stanford, Calif. KIMBERLEE
SOREM,
MD;
MAURICE
LESLIE DRUZIN,
MD
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KEY POINTS
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High-risk pattern. Fetuses at greatest risk include those with marked bradycardia, recurrent late and variable decelerations, and absent variability.
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Normal pattern. In contrast, a normal baseline rate with normal, moderate variability and accelerations, and absence of periodic patterns (decelerations) predicts fetal well-being.
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Tips on interpretation. Deciphering fetal heart rate patterns entails making observations over time. Many patterns acquire increased significance when there is a trend toward persistent, significant departures from baseline with decreased variability, loss of accelerations, or persistent episodic or periodic decelerations, particularly with loss of variability.
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True or false: Electronic fetal monitoring reduces the incidence of cerebral palsy and infant morbidity and mortality.
Unfortunately, the statement is false, although patients continue to believe it is true. As a result, a large proportion of obstetrics liability cases center on electronic fetal monitoring (EFM): 43% of all lawsuits alleging obstetric malpractice, 52% of cases involving a stillborn fetus or neonatal death, and 66% of cases involving a neurologically impaired infant.1
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