In the early 1970s, electronic fetal monitoring (EFM) during labor and delivery was introduced to keep an eye on babies and intervene surgically if necessary. The goal was to reduce the risk of cerebral palsy and death resulting from insufficient oxygen to the fetal brain. Today, although most babies delivered in the United States are monitored by EFM, there is no evidence that this practice is beneficial.
“The technology became accepted practice before we knew if it worked or not. The stillbirth rate has not changed, and the rate of cerebral palsy has increased,” says Alison Cahill, MD, assistant professor of obstetrics and gynecology at Washington University School of Medicine in St. Louis and a Robert Wood Johnson Foundation physician faculty scholar. “We also believe EFM has had a negative effect by contributing to the drastic rise in cesarean section rates in the past 20 years.”
Cahill and her colleagues at the School of Medicine have received a five-year, $3.5 million grant from the National Institute of Child Health and Human Development to better understand the link between fetal heart decreases during labor and brain damage to newborns. The scientists will compare fetal heart rate patterns to neonatal outcomes in 7,000 term deliveries.
“Physicians are intervening on EFM recordings they think have particular meaning, but the recordings are not accurately predicting which babies will have neurological damage,” Cahill says. “If we can learn more about these recordings and what they mean, we can possibly reduce the number of C-sections and also improve newborn care.”
In the study, researchers will assess the EFM recordings of women 120 minutes prior to delivery and see if the recordings predict which newborns will suffer brain damage.
In one segment of the study, 200 full-term babies delivered at Barnes-Jewish Hospital will have a cord blood sample drawn and receive magnetic resonance imaging (MRI) of their brain. They also will undergo a standard brain function test, which includes moving the infant’s arms and legs while looking for behavioral responses.
This study will help scientists better understand the relationship between fetal monitoring, fetal cord blood and brain images. Fetal cord blood can detect the amount of oxygen going to the brain during delivery.
“With this study, we hope to develop a way to predict brain damage based on EFM recordings physicians see every day in the delivery room,” Cahill says. “This is an important issue for the health of babies.”
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Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.