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November 20, 1981, Vol 246, No. 20 >
ARTICLE | November 20, 1981

Electronic Fetal Monitoring FREE

[+] Author Affiliations

This report is not intended to serve as a standard of medical care. Standards of medical care that are determined locally and are constantly subject to change are established on the basis of all the several facts of the individual case. Reprint requests to the Division of Scientific Activities, Council on Scientific Affairs, American Medical Association, 535 N Dearborn St, Chicago, IL 60610 (Richard J. Jones, MD).


JAMA. 1981;246(20):2370-2373. doi:10.1001/jama.1981.03320200052027
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References

DURING the past two decades, there has been a substantial decrease in perinatal mortality. There has also been a concomitant increase in the use of technology in monitoring of pregnancies, as indicated by the use of continuous electronic fetal monitoring (EFM) during labor in as many as 60% to 70% of pregnancies.1,2

This trend in the increasing use of EFM has been associated with opposing societal forces that include (1) an increased emphasis on the "natural" birthing process in which any intervention is viewed with concern; (2) a greater demand for demonstrating efficacy of common practices as well as new technologies; and (3) a greater emphasis on cost-benefit and cost-risk analysis.

Challenging the use of EFM most dramatically was a report by Banta and Thacker3 that was given unusually wide play in the lay press. This study related the increase in cesarean section rates to the greater use

REFERENCES

1 +
Obstetrical Practice in the United States: Hearing Before the Subcommittee on Health and Scientific Research, Senate Committee on Human Resources. US Senate, 95th Congress, second session, April 17, 1978.
2 +
Dilts RC:  Current practices in antepartum and intrapartum fetal monitoring . Am J Obstet Gynecol 1976;;126:491-494.
3 +
Banta HD, Thacker SB: Costs and Benefits of Electronic Fetal Monitoring . National Center for Health Services Research, US Dept of Health, Education, and Welfare, 1978;.
4 +
Report of the Task Force on Predictors of Fetal Distress . Consensus Development Conference on Antenatal Diagnosis, Bethesda, Md, National Institute of Child Health and Human Development. (March 5) to 7, 1979;.
5 +
Stein Z, Susser M:  Mental retardation , in Preventive Medicine and Public Health . New York, Appleton-Century-Croft, 1979;.
6 +
McDonald AD:  Severely retarded children in Quebec: Prevalence, cause, and care . Am J Ment Defic 1973;;78:205-215.
7 +
Drillien CM:  Studies in mental handicaps: II. Some obstetric factors of possible aetiological significance . Arch Dis Child 1968;;43:283-294.
8 +
Alberman E:  Factors influencing perinatal wastage . Clin Obstet Gynaecol 1974;;1:1-15.
9 +
Fukikura T, Klionsky B:  The significance of meconium staining . Am J Obstet Gynecol 1975;; 121:45-50.
10 +
Miller FC, Sacks DA, Yeh S, et al:  Significance of meconium staining during labor . Am J Obstet Gynecol 1975;;122:573-580.
11 +
Benson RC, Schubeck F, Deutschberger J, et al:  Fetal heart rate as a predictor of fetal distress: A report from the collaborative project . Obstet Gynecol 1968;;32:259-266.
12 +
Haverkamp AD, Thompson HE, McFee JG, et al:  The evaluation of continuous fetal heart rate monitoring in high-risk pregnancy . Am J Obstet Gynecol 1976;;125:310-320.
13 +
Kelso IM, Parsons RJ, Lawrence GF, et al:  An assessment of continuous fetal heart rate monitoring in labor . Am J Obstet Gynecol 1978;; 131:526-532.
14 +
Haverkamp AD, Orleans M, Langendoerfer S, et al:  A controlled trial of the differential effects of intrapartum fetal monitoring . Am J Obstet Gynecol 1979;;134:399-412.
15 +
Chan WH, Paul RH, Towes J:  Intrapartum fetal monitoring: Maternal and fetal morbidity and perinatal mortality . Obstet Gynecol 1973;; 41:7-13.
16 +
Kelly VC, Kulkarni D:  Experience with fetal monitoring in a community hospital . Obstet Gynecol 1973;;41:818-824.
17 +
Tutera G, Newman RL:  Fetal monitoring: Its effects on the perinatal mortality and cesarean section rates and its complications . Am J Obstet Gynecol 1975;;122:750-754.
18 +
Paul RH, Huey JR, Yaeger CF:  Clinical fetal monitoring—its effects on cesarean section rate and perinatal mortality: Five-year trend . Postgrad Med 1977;;61:160-166.
19 +
Amato JC:  Fetal monitoring in a community hospital: A statistical analysis . Obstet Gynecol 1977;;50:269-274.
20 +
Neutra RR, Fineberg SE, Greenland S, et al:  Effects of fetal monitoring on neonatal death rates . N Engl J Med 1978;;299:324-326.
21 +
Renou P, Chang A, Anderson I, et al:  Controlled trial of fetal intensive care . Am J Obstet Gynecol 1976;;126:470-476.
22 +
Okada DM, Chow AW, Bruce VT:  Neonatal scalp abscess and fetal monitoring: Factors associated with infection . Am J Obstet Gynecol 1977;;129:185-189.
23 +
Hagen D:  Maternal febrile morbidity associated with fetal monitoring and cesarean section . Obstet Gynecol 1975;;46:260-262.
24 +
Gassner CB, Ledger WJ:  The relationship of hospital-acquired maternal infection to invasive intrapartum monitoring techniques . Am J Obstet Gynecol 1976;;126:33-37.
25 +
Mann LF, Gallant S:  Modern indications for cesarean section . Am J Obstet Gynecol 1979;; 135:437-441.
26 +
Bottoms SF, Rosen MG, Sokol RJ:  The increase in the cesarean birth rate . N Engl J Med 1980;;302:559-563.
27 +
Trudinger BJ, Pryse-Davies J:  Fetal hazards of the intrauterine pressure catheter: Five case reports . Br Obstet Gynecol 1978;;85:567-572.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Obstetrical Practice in the United States: Hearing Before the Subcommittee on Health and Scientific Research, Senate Committee on Human Resources. US Senate, 95th Congress, second session, April 17, 1978.
2 +
Dilts RC:  Current practices in antepartum and intrapartum fetal monitoring . Am J Obstet Gynecol 1976;;126:491-494.
3 +
Banta HD, Thacker SB: Costs and Benefits of Electronic Fetal Monitoring . National Center for Health Services Research, US Dept of Health, Education, and Welfare, 1978;.
4 +
Report of the Task Force on Predictors of Fetal Distress . Consensus Development Conference on Antenatal Diagnosis, Bethesda, Md, National Institute of Child Health and Human Development. (March 5) to 7, 1979;.
5 +
Stein Z, Susser M:  Mental retardation , in Preventive Medicine and Public Health . New York, Appleton-Century-Croft, 1979;.
6 +
McDonald AD:  Severely retarded children in Quebec: Prevalence, cause, and care . Am J Ment Defic 1973;;78:205-215.
7 +
Drillien CM:  Studies in mental handicaps: II. Some obstetric factors of possible aetiological significance . Arch Dis Child 1968;;43:283-294.
8 +
Alberman E:  Factors influencing perinatal wastage . Clin Obstet Gynaecol 1974;;1:1-15.
9 +
Fukikura T, Klionsky B:  The significance of meconium staining . Am J Obstet Gynecol 1975;; 121:45-50.
10 +
Miller FC, Sacks DA, Yeh S, et al:  Significance of meconium staining during labor . Am J Obstet Gynecol 1975;;122:573-580.
11 +
Benson RC, Schubeck F, Deutschberger J, et al:  Fetal heart rate as a predictor of fetal distress: A report from the collaborative project . Obstet Gynecol 1968;;32:259-266.
12 +
Haverkamp AD, Thompson HE, McFee JG, et al:  The evaluation of continuous fetal heart rate monitoring in high-risk pregnancy . Am J Obstet Gynecol 1976;;125:310-320.
13 +
Kelso IM, Parsons RJ, Lawrence GF, et al:  An assessment of continuous fetal heart rate monitoring in labor . Am J Obstet Gynecol 1978;; 131:526-532.
14 +
Haverkamp AD, Orleans M, Langendoerfer S, et al:  A controlled trial of the differential effects of intrapartum fetal monitoring . Am J Obstet Gynecol 1979;;134:399-412.
15 +
Chan WH, Paul RH, Towes J:  Intrapartum fetal monitoring: Maternal and fetal morbidity and perinatal mortality . Obstet Gynecol 1973;; 41:7-13.
16 +
Kelly VC, Kulkarni D:  Experience with fetal monitoring in a community hospital . Obstet Gynecol 1973;;41:818-824.
17 +
Tutera G, Newman RL:  Fetal monitoring: Its effects on the perinatal mortality and cesarean section rates and its complications . Am J Obstet Gynecol 1975;;122:750-754.
18 +
Paul RH, Huey JR, Yaeger CF:  Clinical fetal monitoring—its effects on cesarean section rate and perinatal mortality: Five-year trend . Postgrad Med 1977;;61:160-166.
19 +
Amato JC:  Fetal monitoring in a community hospital: A statistical analysis . Obstet Gynecol 1977;;50:269-274.
20 +
Neutra RR, Fineberg SE, Greenland S, et al:  Effects of fetal monitoring on neonatal death rates . N Engl J Med 1978;;299:324-326.
21 +
Renou P, Chang A, Anderson I, et al:  Controlled trial of fetal intensive care . Am J Obstet Gynecol 1976;;126:470-476.
22 +
Okada DM, Chow AW, Bruce VT:  Neonatal scalp abscess and fetal monitoring: Factors associated with infection . Am J Obstet Gynecol 1977;;129:185-189.
23 +
Hagen D:  Maternal febrile morbidity associated with fetal monitoring and cesarean section . Obstet Gynecol 1975;;46:260-262.
24 +
Gassner CB, Ledger WJ:  The relationship of hospital-acquired maternal infection to invasive intrapartum monitoring techniques . Am J Obstet Gynecol 1976;;126:33-37.
25 +
Mann LF, Gallant S:  Modern indications for cesarean section . Am J Obstet Gynecol 1979;; 135:437-441.
26 +
Bottoms SF, Rosen MG, Sokol RJ:  The increase in the cesarean birth rate . N Engl J Med 1980;;302:559-563.
27 +
Trudinger BJ, Pryse-Davies J:  Fetal hazards of the intrauterine pressure catheter: Five case reports . Br Obstet Gynecol 1978;;85:567-572.

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