Haverkamp follow-up on his 1st EFM trial with abstract and links for 21 reference

Albert D.HaverkampM.D., F.A.C.O.G.
Horace E.ThompsonM.D., F.A.C.O.G.
John G.McFeeM.D., F.A.C.O.G.
CurtisCetruloM.D.

Intrapartum electronic fetal heart rate monitoring of the high-risk obstetric patient is thought to improve the perinatal outcome. A prospective randomized study of 483 high-risk obstetric patients in labor was carried out comparing the effectiveness of electronic fetal monitoring with auscultation of fetal heart tones.

The infant outcome was measured by neonatal death, Apgar scores, cord blood gases, and neonatal nursery morbidity.

There were no differences in the infant outcomes in any measured category between the electronically monitored group and the auscultated group.

The cesarean section rate was markedly increased in the monitored group (16.5 vs. 6.8 per cent in the auscultated patients).

The presumptive benefits of electronic fetal monitoring for improving fetal outcome were not found in this study.

A controlled prospective study was conducted to evaluate possible effects of the use of three intrapartum fetal monitoring techniques on the offspring of high-risk mothers in labor after at least 34 weeks’ gestation.

Six hundred and ninety women were randomly assigned to one of the three monitoring groups: auscultation alone, electronic monitoring alone, and electronic monitoring with option to obtain fetal scalp pH.

There were no significant differences among the three groups of offspring with respect to neonatal mortality or morbidity, Apgar scores, cord blood gas values, or Brazelton examinations at ages 2 to 3 days.

Assessment of the infants at 9 months revealed no significant differences in their growth and development as assessed by physical examination, Bayley Scales of Infant Development, and Milani-Comparetti tests. The frequency of delivery by cesarean section was significantly higher in the electronically monitored group than in the auscultated group. This study failed to show beneficial effects of electronic fetal monitoring over auscultated monitoring for high-risk but relatively mature fetuses.