Effects of electronic fetal monitoring on rates of early neonatal death, low Apgar score, and cesarean section.

Using data from the University Hospital in Odense, Denmark, we have studied the effects of electronic fetal monitoring on rates of early neonatal death (death of liveborn within first week of life), low five-minute Apgar score (less than 7), and cesarean section. Approximately 22 000 births occurring in 1974 - 82 were studied, of which 13% were electronically monitored. Monitoring was significantly associated with an elevated cesarean rate in low-risk labors and certain high-risk labors, but appeared not to increase the cesarean rate in all high-risk labors. In high-risk labors, monitoring was associated with an approximate 40% reduction in rates of low Apgar score and early neonatal death, but neither reduction was statistically significant. The associations of monitoring with elevated cesarean rate declined significantly over the study period. These results accord closely with studies conducted in the United States, indicating that monitoring is of benefit in high-risk labors, but leads to excessive cesarean deliveries in low-risk labors. Our study additionally indicates that the effect of monitoring on the cesarean rate has been declining over time.