This week, experts are debating the question of continuous electronic foetal monitoring for all women in labour.
Writing in yesterday’s BMJ, Dr Edward Mullins and Dr Christoph Lees from Imperial College London, UK, argue for the idea.
They state that not to use it "amounts to a misguided blinding of the clinician to the clinical state of the foetus."
The technique is often used for high-risk labours to alert health care staff to the risk of brain damage from hypoxia. It has been shown to be linked with lower early neonatal and overall infant mortality.
Last week a major audit of full-term stillbirths – from the MBRRACE-UK audit – linked them to failures to instigate continuous monitoring.
Even though continuous electronic foetal monitoring may raise the rate of instrumental delivery and caesarean, Dr Mullins and Dr Lees said these procedures may be necessary, "given that appropriately timed intervention is likely to avoid neonatal hypoxia, seizures, and perinatal death".
Professor Peter Brocklehurst of Birmingham Clinical Trials Unit, UK, argued against the idea, as he believes there is a lack of evidence to support it. A recent analysis of almost 37,000 women failed to show a reduction in perinatal mortality and what’s more, "the excess of subsequent deaths caused by the increased risk of caesarean section is a major concern.”
Even for the very highest risk labours, the balance of benefits and harms of electronic foetal monitoring is uncertain, he states.
Currently, "pressure continues from those with vested interests to increase the use of electronic monitoring," he believes, but advances in technology to identify more reliable foetal biomarkers of hypoxia, along with advances in engineering and imaging, "should help us think of new methods of screening for foetal hypoxia.”
Lees, C. and Mullins, E., and Brocklehurst, P. Head to Head: Is continuous electronic fetal monitoring useful for all women in labour? BMJ 6 December 2017; doi: 10.1136/bmj.j5423 [abstract]
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