News Release

‘No justification’ for routine heart-beat test at start of labour

N.B. Please note that if you are outside North America, the embargo for LANCET press material is 0001 hours UK Time Friday, 7 February, 2003.

Peer-Reviewed Publication

The Lancet_DELETED

A routine test which has been used over the past two decades to electronically monitor the heart-beat of a baby at the start of labour is probably no better than intermittent monitoring with a stethoscope, conclude authors of a study in this week's issue of THE LANCET.

Electronic assessment of a baby's heart beat-known as admission cardiotocography-is widely used to identify fetal distress and pregnancies that might benefit from continuous electronic fetal monitoring (an invasive test which generally renders the woman immobile and can lead to caesarean section). This monitoring is used to try to identify babies that become starved of oxygen during labour.

In a prospective randomised trial by Lawrence Impey and colleagues from the National Maternity Hospital in Dublin, Ireland, around 8500 women were randomly assigned either 20 minutes admission cardiotocography or the unit's usual care (intermittent auditory assessment of the baby's heart beat with a stethoscope).

There was no difference in infant death or moderate to severe infant illness between women from both groups (around 1.3% for both cardiotocography and stethoscope assessment). There was, however, no increase in the proportion of caesarean section, use of forceps, or episiotomy in women given admission cardiotocography.

Lawrence Impey comments: "The findings of this trial demonstrate that a widespread and expensive practice is largely unjustified. By concentrating our attention on the pattern of the baby's heart-beat in labour we are seeing only a fraction of the causes of stillbirth and neonatal handicap. We need better research to understand the processes behind these. Only then can we improve things in the years to come, rather than play catch-up by evaluating what we have done in years past."

###

An accompanying Commentary (p 445) by Stephen B Thacker and Donna F Stroup from the Centers for Disease Control and Prevention, Atlanta, USA, concludes: 'The extent of use of admission cardiotocography is not well documented, but widespread use of admission cardiotocography should be discouraged until better evidence from randomised trials that examine efficacy and safety in populations that are likely to benefit, is available.'

Contact: Dr Lawrence Impey, Department of Feto-Maternal Medicine, John Radcliffe Hospital Women's Centre, Level 4, Headley Way,
Headington, OXFORD OX3 9DU, UK;
T) 44-186-522-2969/ 221710 F) 44-186-522-1188;
E) Lawrence.Impey@orh.nhs.uk

Dr Stephen B Thacker, Epidemiology Program Office, Centers for Disease Control and Prevention,
Atlanta, GA 30333, USA;
E) sbt1@cdc.gov


Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.