The paradox of electronic fetal monitoring: more data may not enable us to predict or prevent infant neurologic morbidity

Abstract

Electronic fetal heart rate monitoring has been used to identify periods of fetal risk, with the hope that clinical intervention would avoid the potential for perinatal death or neurologic damage. A literature review of 10 infant studies failed to document fetal heart rate patterns associated with neurologic injury or protocols for intervention to avoid neurologic injury. A separate analysis of fetal heart rate patterns from 55 brain-damaged infants failed to find consistent patterns that foreshadowed the observed brain injury. These findings should not be surprising, because the majority of infant brain damage occurs outside the intrapartum period and because electronic monitoring may identify times of fetal risk but was never expected to identify brain damage.