Electronic fetal monitoring and clinical practice. A survey of obstetric opinion

A. B. Cohen, H. Klapholz, M. S. Thompson

Research output: Contribution to journalArticle

Abstract

Both the areas of consensus and those of diversity in the perceptions and hypothetical actions of knowledgeable obstetricians in using EFM are noteworthy. Our findings are in line with those of other investigators, who found that obstetricians viewing the same oxytocin challenge test results agreed 52% of the time, and of others, who observed philosophic differences among physicians contemplating surgical intervention in cases of acute appendicitis. To some observers, the degree of consensus seen here - ranging from 59% to 69% - is remarkable, given the complexity of FHR pattern interpretation and the fact that uniformity of opinion may be neither reasonable nor attainable. Practitioners might well benefit from studying these principles and applying them to their own situations. Specifically, it would appear prudent to consider fetal heart rate patterns such as variable decelerations with slow recovery, marked bradycardia with normal baseline variability, and even a normal baseline rate with evidence of decreased variability as nonreassuring. Tachycardias accompanied by either normal or decreased variability should also be viewed with suspicion, but tachycardias with absent baseline variability warrant closer attention as ominous patterns. The availability of scalp blood pH sampling appears to make a difference in subsequent clinical course of action, and is the preferred choice among sample obstetricians when confronted by such FHR patterns as late decelerations with or without decreased baseline variability, variable decelerations with slow recovery and/ or decreased variability and moderate bradycardia with decreased variability. Scalp sampling also is useful in evaluating various tachycardias, as well as a normal baseline rate accompanied by decreased variability. Finding an initial scalp blood pH of between 7.20 and 7.25 generally would indicate to the clinician that a repeat scalp sample ought to be done, while the finding of an acidotic pH value (less than 7.20) should make the physician seriously consider immediate delivery. We urge that more studies of the type reported here be performed, not only to provide insight into areas of uncertainty surrounding new technologies, but also to identify common behavioral patterns and practice styles applicable to numerous problems in medicine. The standard evaluative focus on efficacy and safety may be insufficient for optimal clinical assimilation of new technologies. For technologies with discretionary applications and vulnerability to misinterpretation, the practitioner requires guidance. Such guidance can be provided by identifying the extent of consensus among knowledgeable clinicians. When informed opinion is divided, studies such as this can help to delineate the areas of controversy for subsequent investigation.

Original languageEnglish (US)
Pages (from-to)79-95
Number of pages17
JournalMedical Decision Making
Volume2
Issue number1
Publication statusPublished - 1982

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ASJC Scopus subject areas

  • Health Informatics
  • Public Health, Environmental and Occupational Health
  • Nursing(all)
  • Health Information Management

Cite this

Cohen, A. B., Klapholz, H., & Thompson, M. S. (1982). Electronic fetal monitoring and clinical practice. A survey of obstetric opinion. Medical Decision Making, 2(1), 79-95.