my apologies to the couple and colleagues Jan
----- Original Message -----
Sent: Wednesday, September 24, 2003 2:57
PM
Subject: Re: [ozmidwifery] fetal
monitoring
mary have u changed your address? jan
daer mary i sent a lovely couple to you she was
tall and french and he dark and hand some they were all keen on home birth
have they had their yet lots of love jan
----- Original Message -----
Sent: Thursday, September 04, 2003 9:54
AM
Subject: [ozmidwifery] fetal
monitoring
References from
MIDIRS Midwifery Database Search Results
|
|
Your query
20030826-33 has produced 1 results. |
|
(Search Time:
0 seconds - 1 articles -
SortN) |
1.
|
20030826-33# Revisiting the use of the
electronic fetal monitor - Lancet , vol 361, no 9356, February 2003,
pp 445-446 Thacker SB; Stroud
DF - (February 2003) |
|
Concerns about the efficacy and safety of routine
electronic fetal monitoring in labour have led expert
panels in the USA and Canada(1,2) to recommend that such
monitoring be limited to high-risk pregnancies. The latest
systematic review supports that concern;(3) yet, the use
of electronic fetal monitoring in low-risk pregnancies
continues to expand globally. The identification of
high-risk pregnancies that would benefit from the use of
electronic fetal monitoring during labour remains an
important research issue. In this issue of The Lancet,
Lawrence Impey and colleagues report the results of a
randomised controlled trial that assessed the efficacy of
admission cardiotocography for 8580 low-risk women in
labour as measured by reductions in the rate of neonatal
and maternal morbidity and mortality. Like the 1985 trial
from the same institution that assessed the efficacy of
intrapartum fetal monitoring,(4) this study is carefully
designed and well conducted. Taken together with similar
findings from the only other reported trial of this
intervention,(5) the conclusion that routine use of
cardiotocography for 20 minutes on admission to the
delivery ward does not improve neonatal outcome is
reasonable. Several aspects of the Impey report deserve
comment. The investigators were very careful in the
implementation of their trial. Randomisation of women to
the treatment or control group was blinded and
statistically based. The authors used an appropriate
intention-to-treat analysis and prespecified any subgroup
analyses. Non-parametric methods were used appropriately
when data failed to satisfy Gaussian assumptions. The
analysis examined the effect of changing the method of
randomisation during the trial. One concern about the
study design is that the power calculation assumed a 50%
reduction in risk, whereas practitioners might find a 25%
reduction clinically meaningful. This issue, along with
difficulties in generalising to other populations from two
trials (the Impey study and Mires et al(5)) done in
populations at similar risk, may mean that further trials
are still warranted. The finding that there was no
increase in caesarean delivery rate, for example, could
relate to a low rate of caesarean delivery at this
hospital compared with other institutions. The study by
Impey and colleagues provides no evidence that the routine
use of cardiotocography for 20 minutes on admission is
effective for identifying pregnancies that will benefit
from electronic fetal monitoring in labour, but additional
trials, particularly among high-risk populations, might
allow a meta-analysis so that as much could be known about
the value of admission cardiotocography as about EFM
during labour.(3) It is important to explore new and
better uses of technologies in medicine. However,
technology must not be allowed to diffuse unchecked. The
use of electronic fetal monitoring in low-risk pregnancies
is of limited effectiveness and carries an increased risk
of interventions including instrumental delivery,
caesarean delivery, augmentation of labour, and epidural
anaesthesia.(3) The lessons learnt too slowly from the
experience with electronic fetal monitoring are relevant
for admission cardiotocography.(6) Increased information
on admission will not necessarily lead to better clinical
outcomes. New technologies must be evaluated before their
widespread implementation and randomised trials are
critical to a valid assessment of a screening technology
such as admission cardiotocography. Even the best trials
have limitations, if only in generalisability. Sometimes
the best studies are done in settings that are not readily
transferable to other places because of differences in
resources or characteristics of the study population.
Systematic reviews and cumulative meta-analyses can help
to address the limitations of single trials. The extent of
use of admission cardiotocography is not well documented,
but widespread use of admission cardiotocography should be
discouraged until better evidence from randomised trials
that examine efficacy and safety in populations that are
likely to benefit, is available. (6 references) (Author)
| |
|
|
-- ©2003 MIDIRS --
All rights reserved --
|
MIDIRS web site is
provided for reference information only. MIDIRS is not responsible or
liable for any diagnosis made by a user based on the content of the
website. Although great care is taken to ensure reference information
is both suitable and accurate,MIDIRS is not liable for the contents of
any external internet sites referenced, nor does it endorse any
commercial product or service mentioned or advised on any of these
sites. |
|