Impact of routine fetal monitoring during labor on fetal outcome with long-term follow-up.
A computerized system for the storage of antenatal, intrapartal, and neonatal data has been used since 1973. The present study evaluated the influence of changed neonatal and obstetric practices, with special regard to routine fetal monitoring. Three periods were studied: 1973-1974 (6,542 deliveries, only selected high-risk patients monitored); 1975-1976 (6,857 deliveries, high-risk patients monitored); 1977-1979 (9,638 deliveries, 90% monitored). The numbers of infants with an Apgar score less than 7 at 1 and 5 min were similar in 1973-1974 and 1975-1976, but the number was significantly reduced in 1977-1979. During the years studied, all but eight infants with an Apgar score less than 7 at 5 min participated in a scheduled long-term follow-up (at least 14 mo). In 1973-1974, 25 infants (35.2%) demonstrated neurological handicaps. In 1975-1976, 14 infants (19.2%) had sequelae; in 1977-1979, only three infants (4.6%) were damaged. Trend analysis showed a significant reduction in the number of infants with neurological sequelae through the years; the reduction was significant for premature and low-risk infants but not for mature high-risk infants. The improved short-term and long-term fetal outcomes seem to be largely a result of routine fetal monitoring with all its implications for obstetric and neonatal management; the significant reduction in neurological sequelae, even after correction for other changes in obstetric routines, supports this suggestion.
D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000209:etiology; D002547:Cerebral Palsy / Q000209:etiology; D002585:Cesarean Section; D002675:Child, Preschool; D004827:Epilepsy / Q000209:etiology; D005260:Female; D005323:Fetal Monitoring; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007743:Labor, Obstetric; D009422:Nervous System Diseases / Q000209:etiology; D011247:Pregnancy; D011596:Psychomotor Disorders / Q000209:etiology; D012306:Risk