The Skeptical OB - Page 10

[Buzzbuzz]

Mambera --

What do you think about the 2011 Chen study which examined over 1,700,000 births in the US and concluded that EFM reduced the number of babies with apgars of less than 4, reduced neonatal seizures and halved early (birth to 6 days of age) neonatal death rates?  It can be found here at http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937811004807.pdf.

[starrlamia]

that study compares EFM to no monitoring, of course it is going to show improved outcomes.

 

Originally Posted by Buzzbuzz 

Mambera --

What do you think about the 2011 Chen study which examined over 1,700,000 births in the US and concluded that EFM reduced the number of babies with apgars of less than 4, reduced neonatal seizures and halved early (birth to 6 days of age) neonatal death rates?  It can be found here at http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937811004807.pdf.

[nikkijames]

Originally Posted by starrlamia 

that study compares EFM to no monitoring, of course it is going to show improved outcomes.

 

 

[Katie8681]

The study authors were kind of flippant about how nonspecific the "no EFM" group was. In their comment, "The possible explanations

for not using EFM include women undergoing repeat cesarean delivery, clinician’s preference for IA, planned home births, precipitous delivery, nonavailability of EFM during busy hours, and not using EFM at the limit of viability". In this study they excluded repeat c/s and births outside of viability, so the no EFM group may contain providers using IA according to published guidelines, IA NOT adhering to guidelines, women who are rushed in emergently with no monitoring whatsoever, and so on.  Also the analysis of effect of cEFM broken down by gestational age does not further split the results after 37 weeks, and GAs of up to 44 weeks (!!) were included.  37 weeks is considered early term, and past 42 is postterm, both of which are associated with worse outcomes. Certainly past 42 weeks is no longer considered "low risk".  

 

However you feel about cEFM, you've got to admit this study has some major holes in it. It has an impressively large n, but I would be far more interested in a randomized controlled trial, in one large facility, in which low risk women between 38 and 42 weeks were monitored either by IA _according to AWHONN guidelines_ or by cEFM. 

 

In fact I'm off to look for something like that :)  I love hunting for papers.