Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 May;121(5):927-933.
doi: 10.1097/AOG.0b013e318289510d.

Electronic fetal monitoring in the United States: temporal trends and adverse perinatal outcomes

Cande V Ananth  1 , Suneet P Chauhan, Han-Yang Chen, Mary E D'Alton, Anthony M Vintzileos
Affiliations

Electronic fetal monitoring in the United States: temporal trends and adverse perinatal outcomes

Cande V Ananth et al. Obstet Gynecol. 2013 May.

Abstract

Objective: To examine trends in electronic fetal monitoring (EFM) use and quantify the extent to which such trends are associated with changes in rates of primary cesarean delivery and neonatal morbidity and mortality.

Methods: We carried out a retrospective study of more than 55 million nonanomalous singleton live births (24-44 weeks of gestation) delivered in the United States between 1990 and 2004. Changes in the risks of neonatal mortality, cesarean delivery, and operative vaginal delivery for fetal distress, 5-minute Apgar score lower than 4, and neonatal seizures (at 34 weeks of gestation or after) were examined in relation to changes in EFM use.

Results: Electronic fetal monitoring use increased from 73.4% in 1990 to 85.7% in 2004, a relative increase of 17% (95% confidence interval 16-18%). This increase was associated with an additional 5% and 2% decline in early and late neonatal deaths, respectively, at 24-33 weeks of gestation as well as a 4-7% additional decline in the 5-minute Apgar score lower than 4 at 24-33, 34-36, and 37-44 weeks of gestation. Increasing EFM use was associated with a 2-4% incremental increased rate of both cesarean delivery and operative vaginal delivery for fetal distress at 24-33, 34-36, and 37-44 weeks of gestation. Increasing EFM was not associated with any temporal changes in the rate of neonatal seizures.

Conclusions: The temporal increase in EFM use in the United States appears to be modestly associated with the recent declines in neonatal mortality, especially at preterm gestations.

Level of evidence: II.

PubMed Disclaimer

Comment in

References

    1. Hon EH. The electronic evaluation of the fetal heart rate; preliminary report. Am J Obstet Gynecol 1958;75:1215–30.
    1. Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. ACOG Practice Bulletin No. 106. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2009;114:192–202.
    1. Chen HY, Chauhan SP, Ananth CV, Vintzileos AM, Abuhamad AZ. Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States. Am J Obstet Gynecol 2011;204:491.e1–10.
    1. Taffel SM, Ventura SJ, Gay GA. Revised U.S. certificate of birth—new opportunities for research on birth outcome. Birth 1989;16:188–93.
    1. Ananth CV. Menstrual versus clinical estimate of gestational age dating in the United States: temporal trends and variability in indices of perinatal outcomes. Paediatr Perinat Epidemiol 2007;21(suppl 2):22–30.