Abstract
Objective: To evaluate the use of electronic fetal monitoring (EFM) as a means of reducing cerebral palsy (CP) in sub-Saharan Africa (SSA).
Background: CP is a significant problem in SSA where it is characteristically albeit erroneously considered synonymous with birth asphyxia, leading to the increasing use of EFM in a misguided effort to reduce perinatal morbidity and mortality.
Design/Methods: We performed a systematic literature review of relevant publications since EFM’s inception a half-century ago (PUBMED, SCOPUS and COCHRANE), and surveyed neurologists, paediatricians and obstetricians in the East African region.
Results: EFM has a 99.8% false positive rate, does not predict or prevent CP or any other neonatal neurological injury and has no proven efficacy in routine childbirth. EFM causes significant harm to mothers and babies by prompting unnecessary C-sections with all of the attendant complications of that procedure, leading to considerable risks in subsequent pregnancies including lifelong repeat C-sections with high rates of operative complications, uterine rupture, and placental abnormalities, all having a higher morbidity and mortality in SSA. Recent evidence suggests babies born by C-sections suffer an increased risk of chronic and autoimmune diseases. Additionally, while EFM use without informed consent is unethical, it may be challenging to obtain true informed consent in the SSA population.
Conclusions: EFM is a waste of extremely scarce resources while simultaneously adding another layer of useless staff training complexity as well as significant morbidity and mortality to a desperately critical situation. The authors recommend ending continuous EFM in routine pregnancies in SSA, which aligns with the Australian, Canadian, New Zealand and United Kingdom guidelines, follows recent USA recommendations, and comports with the World Health Organization Quality of Care Network goals. EFM related funding should be redirected to improve healthcare for mothers, train birth attendants, and focus on therapeutic intervention for children with CP and related neurological disorders.
Disclosure: Dr. Johnston has nothing to disclose. Dr. Sartwelle has nothing to disclose. Dr. Arda has nothing to disclose. Dr. Zebenigus has nothing to disclose.
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
