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On electronic fetal heart rate monitoring.

Management of fetal heart rate (FHR) patterns is rapidly changing following the 2008 consensus guideline from the National Institutes of Health and Child Development (NICHD) and a 2010 Practice Bulletin from the American College of Obstetricians and Gynecologists (ACOG). The FHR category II identified in the NICHD document does not assist clinical decision making. Although ongoing research is addressing this gap, multidisciplinary development of FHR interpretation and management systems will aid clinical practice. In a recent editorial on FHR monitoring, Dr. Nancy Lowe (2011) highlighted a key point in the commentary by Grimes and Peipert that almost every “positive” electronic fetal monitoring (EFM) test is wrong in that it does not benefit the newborn and harms women due to unnecessary operative procedures (Grimes & Peipert, 2010). If this is so, there is something enormously wrong with what we call a “positive” result. Let’s not throw the baby out with the bath water before taking a more nuanced look at the effectiveness of FHR monitoring in obstetrics today.