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eFM statement from RCM and RCOG

31 July, 2017

eFM statement from RCM and RCOG

A joint statement on electronic fetal monitoring (eFM) has been published by the RCM and the RCOG, in which the colleges’ positions are made clear on current guidelines and recommendations. 

One of the key messages is that the results of eFM are often difficult to interpret and should not be used alone to make clinical decisions. 

Referencing the RCOG Each Baby Counts report, the statement says that key management decisions during labour should take into account a number of relevant factors. 

These include the mother’s history, stage and progress in labour, any antenatal risk factors and any other signs that the baby may not be coping with labour.  

The report also recognises the importance of the ‘fresh eyes’ approach to eFM, as set out by Donnelley and Hamilton. This suggests a midwife or obstetrician regularly reviews a fetal heart trace with a colleague. It is now accepted good practice. 

The official evidence-based guidance around eFM says that it is not routinely recommended for healthy women at low risk of complications in established labour. The fetal heart rate is instead measured intermittently during established labour using a handheld monitor. 

eFM is most commonly recommended where there are complications, such as where a baby is compromised through poor placental function and the baby is growth restricted.

Cathy Warwick, RCM chief executive, said: ‘Focusing on eFM in isolation, which too often happens after something has gone wrong, is not helpful and will not get us to the root of the problem.  

‘It is also important to recognise that eFM results can be difficult to interpret, even for experts. Our day to day practice has to take that into account. A culture of multidisciplinary working which ensures ease of referral and immediate access to a second opinion will enhance safety.’

Cathy added that midwives and obstetricians often work in highly pressurised and busy environments where there may be inadequate numbers of staff. 

‘In these circumstances, poor decisions can be made. The wider health system has a responsibility to ensure individuals work in systems that support them to provide care of the highest possible standard,’ she said.

To read the full statement, click here.

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