Continuous electronic fetal monitoring (EFM) leads to significantly greater rates of caesareans and operative vaginal deliveries in low risk patients compared to those monitored with intermittent auscultation. Intermittent auscultation results in no significant difference in the number of infant deaths during and shortly after labour, cerebral palsy rates, use of drugs for pain relief, and cord blood acidosis in low risk patients. Further, EFM restricts movement and positioning, excludes the option of using a birthing pool, and requires greater resource use to continuously interpret fetal heart rate tracings. EFM therefore increases risk of intervention and decreases choice without providing meaningful benefit to patient or neonatal outcomes in low risk patients.
Sources:
Alfirevic Z, et al. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2017 Feb 3;2:CD006066. PMID: 28157275.
Leveno KJ, et al. A Prospective Comparison of Selective and Universal EFM in 34,995 Pregnancies. N Engl J Med. 1986 Sep 4;315(10):615-9. PMID: 3736600.
Liston R, et al. Fetal Health Surveillance: Antepartum and Intrapartum Consensus Guideline: Fetal Health Surveillance in Labour [Internet]. J Obstet Gynaecol Can. 2007 Sep [cited 2017 May 29];29(9):S27.
Mires G, et al. Randomised controlled trial of cardiotocography versus Doppler auscultation of fetal heart at admission in labour in low risk obstetric population. BMJ. 2001 Jun 16;322(7300):1457-60; discussion 1460-2. PMID: 11408301.