The Use of Fetal Surveillance During Labor in the Federal Republic of Germany

Abstract

Medical technology has improved at a staggering pace and obstetrics is one of the fields most affected by this progress. Since its introduction in 1958 (Caldeyro-Barcia 1958) fetal heart rate (FHR) monitoring has become a widely used modality. It is estimated (Hobbins et al. 1979) that the technique is used in over half the deliveries in the United States. Recent investigations (1982) revealed that in Bavaria 88% of all fetuses during labor are monitored, 69.2% of them continously (F. K. Wulf, personal communication 1983). Similar figures (90%) have been published by Baumgarten, who reviewed 44750 deliveries in the German-speaking countries (Baumgarten 1981). Electronic fetal monitoring has been subject to criticism (Haverkamp et al. 1976; Banta and Thacker 1979a; Baumgarten 1981; Dunn 1979): the method requires application of transducers and electrodes which are connected to machines by wires or small cables. Some feel that this “confinement” of the mother detracts from the spontaneity of the experience. Others have been concerned with its contribution to the overall costs of pregnancy (Banta and Thacker 1979b). Still others have openly questioned the efficacy of this widely accepted technique (Banta and Thacker 1979b; Hobbins et al. 1979). However, during the past few years there has been increasing evidence that FHR monitoring leads to:

• 1. A decrease in neonatal death rate (Amato 1977; Neutra et al. 1978; Paul and Hon 1974; Paul et al. 1980; Tutera and Newman 1975; Bolte 1983; Baumgarten 1981)

• 2. A decrease in fetal morbidity measured by Apgar scores (Amato 1977; Ballas et al. 1980; Gabert and Stenchever 1974, 1977; Mueller-Heubach et al. 1980; Johnstone et al. 1978; Shenker et al. 1975) as well as umbilical pH values (renou et al. 1976; Baumgarten 1981)

• 3. No substantial increase in cesarean section rate (Gabert and Stenchever 1977; Hughey et al. 1977; Mueller-Heubach et al. 1980; Johnstone et al. 1978; Kelso et al. 1978; Bolte 1983; Baumgarten 1981; Boehm et al. 1981; Ramzin and Weil 1981)

• 4. A significant reduction in the number of infants with neurological sequelae (Ingemarsson et al. 1981; Baumgarten 1981)