continuous EFM and GD

Archived User

continuous EFM and GD

Hi Henci,

Do you have any resources that specifically discuss the practice of continuous fetal monitoring in labor on women with gestational diabetes.   Ie: does having GD automatically indicate the need for continuous monitoring or is intermittant ascultation considered a safe alternative if mom's GD is well managed without signs of hypertension?

Many thanks for your help!

Henci Goer

RE: continuous EFM and GD
(in response to Archived User)

No, I don't. It is probably all part of the "GD as high-risk condition" package. In actual fact, according to the Cochrane systematic review on this topic, we don't have any evidence that continuous  EFM improves outcomes even in women with high-risk conditions, which I would argue well-controlled GD with no other health problems is not. (See other posts on GD on this Forum.) Here is what I wrote summarizing data from the review in  the manuscript of the EFM chapter in the forthcoming new edition of Obstetric Myths Versus Research Realities: "Among high-risk women (not defined) continuous EFM failed to reduce Apgar scores < 4 at 5 minutes (3 trials, 941 women), NICU admissions (4 trials, 1528 women), neonatal seizures (6 trials, 4805 women), or perinatal death (6 trials, 1974 women)." On the other hand, the same review establishes that continuous EFM has harms. It increases risk of cesarean surgery and of instrumental vaginal delivery.

-- Henci

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