Hello all,
This is fascinating... a 99% false positive rate, and positive linkage
between use of EFM and both vacuum and forceps, high variability in
interpretation, and more use of it than ever...
_http://www.medscape.com/viewarticle/705210?src=mp&spon=9&uac=26242FK_
(http://www.medscape.com/viewarticle/705210?src=mp&spon=9&uac=26242FK)
"Specific clinical recommendations and conclusions in the revised ACOG
guidelines that are based on good and consistent scientific evidence (level A)
include the following:
• The false-positive rate of EFM for predicting cerebral palsy exceeds
99%.
• The use of EFM is linked to higher rates of both vacuum and forceps
operative vaginal delivery, as well as of cesarean delivery for abnormal FHR
patterns and/or acidosis.
• Recurrent variable decelerations on the FHR tracing should lead to
consideration of amnioinfusion to relieve umbilical cord compression.
• For assessing fetal status, pulse oximetry has not been shown to be
clinically useful.
Specific clinical recommendations and conclusions in the revised ACOG
guidelines that are based on inconsistent scientific evidence (level B) include
the following:
• Interpretation of FHR tracing is subject to high interobserver and
intraobserver variability.
• Reinterpretation of the FHR tracing may not be reliable, especially once
the neonatal outcome is known.
• Use of EFM is not associated with a lower incidence of cerebral  palsy.
...
• During labor, women with high-risk conditions should undergo continuous
FHR  monitoring."
"Women should undergo fetal heartrate monitoring"...and I thought it was
that  huge, ugly wound on the baby's head I was noticing...
Peace,
Judy

Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA

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