Obstetrics Book

Developmental Disorder

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Continuous Electronic Fetal Monitoring

Aka: Continuous Electronic Fetal Monitoring, CEFM
  1. See Also
    1. Fetal Heart Tracing
    2. Structured Intermittent Auscultation (SIA)
  2. Indications
    1. High risk pregnancy (see efficacy below)
      1. See Peripartum Risk to the Fetus
      2. Antepartum factors
        1. Conditions affecting placental insufficiency
        2. Known fetal anomaly
        3. Maternal Preeclampsia or Gestational Hypertension
        4. Maternal Type 1 Diabetes Mellitus
        5. Fetal Growth retardation suspected
      3. Intrapartum factors
        1. Meconium present
        2. Tachysystole
        3. Intrauterine Infection
        4. Vaginal Bleeding
        5. Uterine stimulant (i.e. Oxytocin) use for Labor Induction or augmentation
        6. Low risk patient with concerning on Structured Intermittent Auscultation (SIA)
          1. Irregular Fetal Heart Rate
          2. Fetal Tachycardia (>160 bpm for >10 minutes)
          3. Fetal Bradycardia (<110 bpm for >10 minutes)
          4. Recurrent fetal decelerations after contractions (>50% of contractions)
          5. Prolonged deceleration (2-10 minutes)
    2. External monitoring is not possible
      1. Maternal body habitus
      2. Fetal Position interferes with monitoring
  3. Adverse Effects
    1. See Efficacy below (including False Positive Rate)
    2. Requires amniotomy and increased risk of Chorioamnionitis, vertical transmission HSV and Viral Hepatitis
  4. Technique
    1. Intrauterine scalp electrode placement
    2. Intrauterine pressure catheter placement
  5. Efficacy: Continuous Electronic Fetal Monitoring (CEFM)
    1. CEFM does not significantly improve fetal outcome
      1. Only measurable benefits
        1. Fewer Neonatal Seizures
        2. Good tracing is reassuring for good outcome
      2. No benefit in APGAR Scores
      3. No decrease in NICU admissions
      4. No change in perinatal death rate
      5. No reduction in Cerebral Palsy
        1. Non-reassuring tracing does not predict bad outcome
        2. False Positive Rate 99.8% if ominous tracing
          1. Late Decelerations
          2. Decreased variability
    2. CEFM increases the risk of surgical intervention (False Positive for fetal acidosis in two thirds of cases)
      1. Increases ceserean rate by 20%
      2. Increases operative Vaginal Delivery rate
    3. Consider Informed Consent for CEFM
      1. CEFM may be indicated in high risk pregnancies
      2. Consider intermittent monitoring if low risk
  6. References
    1. Alfirevic (2017) Cochrane Database Syst Rev (1):CD006066 [PubMed]
    2. Arnold (2020) Am Fam Physician 102(3): 158-67 [PubMed]
    3. Devane (2017) Cochrane Database Syst Rev (1):CD005122 [PubMed]
    4. Luthy (1987) Obstet Gynecol 69(5):687-95 [PubMed]
    5. Leveno (1986) N Engl J Med 315(10):615-19 [PubMed]

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