Hi Henci, 

We have a Cochrane systematic review aggregating data from 12 trials showing that continuous electronic fetal monitoring (EFM) increases the c/sec rate and decreases the neonatal seizure rate. But if you look at the individual trials, you find that one of them, the second largest, was carried out at the Dublin National Maternity Hospital, the hospital that is Ground Zero for active management of labor, a protocol that treats any woman not progressing at the average rate with high-dose oxytocin. That is the trial you cite. In that trial, not surprisingly, excess neonatal seizures occurred in the group with the longer labors who received oxytocin, and continuous EFM was protective. The neonatal seizure rate overall in this population was 10 times that of the biggest study (3 per 1000 vs. 3 per 10,000), which took place in a U.S. hospital. Because of the size of the Dublin trial, and the high seizure rate compared with other trials, if it were excluded, the difference between rates between EFM and intermittent auscultation would almost certainly become clinically insignificant if not statistically insignificant (i.e., likely to be due to chance). On the other hand, it appears that if you're going to expose women to high-dose oxytocin, continuous EFM could help protect the fetus from the adverse consequences of doing that. Since women are not in a position to dictate what oxytocin protocol their ob uses, my recommendation was to use EFM when being induced. Of course, the better solution would be to reserve induction and augmentation for when they are truly needed and to use oxytocin regimens based on the research evidence of how oxytocin is metabolized, but I don't see that happening any time in the near future.

-- Henci