There are two requirements for a screening test. The clinical problem must justify intervention. Intrapartum fetal asphyxia is important and in selected circumstances justifies intervention. The benefits of the test must outweigh the harm. It was recognized in the late 1970s that this had not been determined.
The introduction of EFM was associated with a reduction in the number of intrapartum fetal deaths . However, intrapartum fetal deaths continue to be reported in studies of perinatal mortality. In the UK Confidential Enquiry into stillbirths and death in infancy, 9% of all deaths between 20 and 44 weeks of gestation were related to labour and, of the normally formed babies weighing at least 2500 g, 4.3% could be linked to intrapartum events .
Well-designed, randomized, controlled trials are proposed as a means of providing a measure of the true risks and benefits of a medical intervention. There have been no randomized clinical trials to compare no fetal heart rate surveillance with intermittent fetal heart rate auscultation. Nine randomized clinical trials, three with electronic fetal monitoring alone and six with electronic fetal monitoring with scalp sampling, have been analysed in the Cochrane Pregnancy and Child Birth Data Base [19,20]. The randomized clinical trials comparing intermittent auscultation and continuous EFM have not provided consistent evidence that EFM was associated with a decrease of fetal and newborn morbidity. The randomized clinical trials have made an important contribution, confirming the occurrence of false positive interpretation of electronic fetal heart rate recording with unnecessary interventions. These studies have demonstrated that electronic fetal heart rate monitoring in relation to intermittent auscultation has been associated with increased incidence of Caesarean section for fetal distress and dystocia, increased operative delivery and general anaesthesia. It must be recognized that these outcomes are not due to the method of fetal heart rate surveillance but are a result of inappropriate interpretation of the fetal heart rate data.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.