A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies

K. J. Leveno, F. G. Cunningham, S. Nelson, M. Roark, M. L. Williams, D. Guzick, S. Dowling, C. R. Rosenfeld, A. Buckley

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

We investigated the effects of using intrapartum electronic fetal monitoring in all pregnancies, as compared with using it only in cases in which the fetus is judged to be at high risk. Predominant risk factors included oxytocin stimulation of labor, dysfunctional labor, abnormal fetal heart rate, or meconium-stained amniotic fluid. This prospective alternate-month clinical trial took place over a 36-month period during which 34,995 women gave birth. In alternate months, either 7 (for 'selective monitoring') or 19 (for 'universal monitoring') fetal monitors were made available in the labor and delivery unit. During the 'selective' months, 6420 of 17,409 women (37 percent) were electronically monitored, as compared with 13,956 and 17,586 women (79 percent) during the 'universal months'. Universal monitoring was associated with a small but significant increase in the incidence of delivery by cesarean section because of fetal distress, but perinatal outcomes as assessed by intrapartum stillbirths, low Apgar scores, a need for assisted ventilation of the newborn, admission to the intensive care nursery, or neonatal seizures were not significantly different. We conclude that not all pregnancies, and particularly not those considered at low risk of perinatal complications, need continuous electronic fetal monitoring during labor.

Original languageEnglish (US)
Pages (from-to)615-619
Number of pages5
JournalNew England Journal of Medicine
Volume315
Issue number10
StatePublished - 1986

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Cardiotocography
Pregnancy
Fetal Monitoring
Meconium
Fetal Distress
Fetal Heart Rate
Stillbirth
Apgar Score
Nurseries
Oxytocin
Amniotic Fluid
Critical Care
Cesarean Section
Ventilation
Seizures
Fetus
Clinical Trials
Parturition
Newborn Infant
Incidence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies. / Leveno, K. J.; Cunningham, F. G.; Nelson, S.; Roark, M.; Williams, M. L.; Guzick, D.; Dowling, S.; Rosenfeld, C. R.; Buckley, A.

In: New England Journal of Medicine, Vol. 315, No. 10, 1986, p. 615-619.

Research output: Contribution to journalArticle

Leveno, K. J. ; Cunningham, F. G. ; Nelson, S. ; Roark, M. ; Williams, M. L. ; Guzick, D. ; Dowling, S. ; Rosenfeld, C. R. ; Buckley, A. / A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies. In: New England Journal of Medicine. 1986 ; Vol. 315, No. 10. pp. 615-619.
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