Clinical management guidelines for EFM

Faced with the available evidence, national organizations began to prepare consensus papers in regard to fetal surveillance during labour. Examples of the most recent clinical guidelines include: ACOG Technical Bulletin Number 207, 1995 in United States [21]; SOGC Clinical Practice Guideline Number 112, 2001 in Canada [22]; and RCOG Evidence-based Clinical Guideline Number 8, 2001 in the United Kingdom [23]. These guidelines prepared by recognized experts in the field endeavoured to reflect the best evidence available at that time.

What is missing from all the current guidelines is a specific algorithm for the interpretation of fetal heart rate patterns. The ACOG and the SOGC guidelines classify fetal heart rate patterns as reassuring and non-reassuring. Detailed criteria and time are not noted. The Royal College Evidence-based Guidelines have defined traces as normal, suspicious and pathological. No guidelines have provided data as to the sensitivity, specificity and predictive value of the patterns as defined.

This issue was addressed by an NIH research-planning workshop in 1997 [24]. The specific purpose of the workshop was to develop standardized and unambiguous definitions of fetal heart rate tracings for future research. Although all members of the workshop were of the opinion that EFM was of value, there was no consensus regarding strict guidelines for clinical management using fetal heart rate (FHR) patterns. The position expressed was that many fetuses have FHR tracings that are intermediate between two extremes, that is, normal and patterns so severe that the fetus is at risk of morbidity or mortality. The workshop concluded that evidence-based algorithms for management awaits further research. This view has been recently expressed again [25].

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Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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