Fetal Monitor Risks

[bear14]

Someone posted an article online associating EFM with increased risk to the baby and that it is an outdated and unnecessary technique. Is this true? What do you all think?

[klone, MSN, RN]

In low risk women, continuous fetal monitoring does not improve outcomes, and in fact leads to increased risks for interventions, including C/S.

In certain situations, it's necessary. But for low risk women who are in spontaneous labor, intermittent auscultation is all that's necessary.

[bear14]

How does it lead to increased risks?

[Mr Midwife, BSN, RN]

I think you have seen the term 'risk' used in an incorrect manner. EFM in itself has no effect on the fetus, no more than any other USS device and I've never come across anything which would suggest otherwise.

It is the skill of the person that is intrepreting the CTG which poses the risk factors to the mother and baby diad.

CTG also has a high risk factor of 'false negatives' i.e. a trace which looks suspicious or pathologial does not always truly refelct the condition of the fetus and can often lead to over intervention when used incorrectly. Traces of concern should be complimented with Fetal Scalp Blood Sampling as these give direct information about the oxygenation and acid-base of the infant.

CTG was introduced as a means to decrease long term infant morbidity such as Cerebral Palsy etc. The only contrubution it has made is a reduction in the instance of neonatal seizures but as first commenter said once a CTG is started you start a cascased of interventions and have more likely have intervention such as instrumental delivery or carsarean delivery.

[klone, MSN, RN]

once a CTG is started you start a cascased of interventions and have more likely have intervention such as instrumental delivery or carsarean delivery.

I'm not sure what CTG stands for (continuous...?) but this right here. The machine itself does not pose risk to the fetus, in that it's not harmful rays going into the baby or anything. But the use of the machine, and what it picks up with continuous use, frequently results in interventions that are unnecessary in many/most cases. If you see late decels, you HAVE to act on them, because to know they're there and not DO SOMETHING is negligent. So continuous EFM will pick up things that intermittent ausculatation will not, just due to odds. Most of the time, the things they pick up would be benign and the baby is just fine.

That's one reason I do like STAN technology, but unfortunately it's quite invasive and requires ROM.

[perfexion, ASN, RN]

CTG= cardiotocography. Does anyone work at a hospital where they use STAN? My hospital is so far behind the rest of the world. We just ordered wireless monitors. I've only read about STAN.

[klone, MSN, RN]

Yes, I worked at a facility that used it as part of an MFMU research study.

[LibraSunCNM, BSN, MSN, CNM]

Wow, I just learned something new and interesting! Had never heard of STAN before now and had to look it up.

[chiandre]

How does it lead to increased risks?

Providers tend to surgically intervene when they suspect fetal distress.

[NurseNora, BSN, RN]

Once electronic monitoring is started, most patients are tied to the bed. Less now than in the past, but many younger nurses are not comfortable letting the patient up to walk, or even putting a rocking chair or birthing ball by the monitor. Wireless technology is available, but expensive and not every place has it. I teach the AWHONN fetal monitoring courses and know that younger nurses are uncomfortable with auscultation. One reason I am comfortable with auscultation is that I started before we had EFM. I saw a huge increase in C/S after it was introduced with little improvement in outcome. Once in a great while we would go to the delivery room with a live baby and deliver a surprising 0/0 Apgar baby (you can't heat variability or late decelerations with auscultation). I haven't seen that happen (the surprise part) since EFM, but that's about the only outcome improvement I've seen. They have been able to prove that most Cerebral Palsy is not caused by events during the birth process and that has taken some of the pressure of the malpractice insurance companies, but not really reduced the incidence of CP. EFM is good at showing which fetus is well oxygenated, but very poor at predicting the poorly oxygenated fetus. As Klone said, lots of false positives.

seen.