Intrapartum Fetal Monitoring: A Systematic Review of Evidence, Implications for Current Practice and Future Research

Glenn, Lori

The national cesarean section rate in 2011 is expected to exceed 33%, reflecting a 54% increase since 1996.   There has been concern reported by the major health policy and professional organizations that a critical look at maternal care practices is needed.  Current nursing practice in the care of laboring women is heavily laden with technology not supported in evidence to improve outcomes for mother or baby, and contributing to the increasing cesarean section rate.   One technology that is commonly used by nurses is the continuous electronic fetal monitor.  Since the early 1970’s this has been the routine for intrapartum care. The purpose of this presentation is a systematic review of evidence comparing continuous electronic fetal monitoring and intermittent auscultation and their impact on maternal and neonatal outcomes.  The seven studies included involve 32,138 women over a 25 year span of randomized controlled trials. Maternal outcomes demonstrate an increase in medical interventions, operative delivery, Cesarean section, and use of analgesia and anesthesia. Neonatal outcomes including Apgar scores, evidence of acidosis, neurologic effects, seizures and cerebral palsy do not demonstrate improved outcomes. Consideration is given to the perception of safety related to continuous surveillance provided by the electronic fetal monitor by both bedside nurses and laboring women.  The implications for current nursing practice describe barriers to implementation of routine intermittent auscultation.  Future research will need to demonstrate evidence based practices in the intrapartum care that involve not only continuous electronic fetal monitoring, but also the routine application of technology and medical intervention for laboring women.