2001/17 NICE issues clinical guideline on electronic fetal monitoring

Press release

NICE 2001/ 017 Issued: 8 May 2001

The National Institute for Clinical Excellence has today issued its guidance on the use of Electronic Fetal Monitoring (EFM). The short form guideline published by NICE is derived from a full guideline published by the Royal College of Obstetricians and Gynaecologists.

Electronic Fetal Monitoring is used to monitor a baby's heartbeat continuously during labour. Sensors are placed against the mother's abdomen and are connected to a heart rate monitor, which produces a record of the baby's heartbeat.

Alternatively the midwife or doctor uses a Pinard stethoscope or a "Doppler" to monitor the baby's heartbeat at regular intervals during labour. This is called intermittent auscultation.

The guideline makes a series of recommendations for clinicians on when it is appropriate to use EFM for women in labour. In summary the guideline recommends that for women who have an uncomplicated pregnancy and who are healthy, monitoring should take place at regular intervals using intermittent auscultation. For women who are considered to have high-risk pregnancies, continuous EFM is recommended.

Andrea Sutcliffe (Executive Director and Executive Lead for this Guideline) said, "The guideline covers an important aspect of care in pregnancy. Its recommendations should ensure that electronic fetal monitoring is used in those circumstances where continuous monitoring of the baby's health is required. The guideline will enable women in labour to make decisions about the monitoring of their baby, in consultation with their midwife or doctor, based on the most up to date evidence."

Ends

Notes for Editors:

Background

1. Clinical Guidelines are produced to help health professionals and patients make the right decisions about health care in specific clinical circumstances. Research has shown that if properly developed, communicated and implemented, guidelines can improve patient care. Clinical guidelines sit alongside, and do not replace, the knowledge and skills of experienced health professionals.

2. Full details of the Institute's guidelines development process and principles are published on the NICE web site, (http://www.nice.org.uk/article.asp?a=6834).

3. Copies of these guidelines and supporting documentation will be available on the NICE web site (www.nice.org.uk) from 12pm (lunchtime) on Tuesday 8th May 2001.

4. The Institute's guidance contains details of the

• Who the guidance has been sent to (inside front cover)
• Implementation advice (Section 5)
• Membership of the Guideline Development Group (Appendix A)
• Membership of the Institute's Guidelines Advisory Committee (Appendix B)
• Information for Patients (Appendix C)

The Use of Electronic Fetal Monitoring

5. The Institute's guideline is published on the NICE web site (www.nice.org.uk) and is derived from the full guideline entitled "The Use Of Electronic Fetal Monitoring: The use and interpretation of cardiotocography in intrapartum fetal surveillance", commissioned from the Royal College of Obstetricians and Gynaecologists. It is available on their website: www.rcog.org.uk, on the Institute's website: www.nice.org.ukand on the National Electronic Library for Health's website: www.nelh.nhs.uk The Guideline developers are listed in Appendix A.

6. The guidance identifies when Electronic Fetal Monitoring should be used for women in labour. It provides specific advice for those women who have had an uncomplicated pregnancy and those who have had a high-risk pregnancy, as well as recommendations on interpreting EFM Heart Rate Monitor "traces" and additional tests and therapies used in combination with EFM.

7. Local health communities will need to review existing service provision against this guidance. This review should result in an implementation strategy which will identify the resources required to implement fully the recommendations set out in Section 2 of the guidance, the people and processes involved and the timeline over which full implementation is envisaged. Relevant local clinical guidelines and protocols should be reviewed in light of this guidance and revised accordingly.

General Information

8. The National Institute for Clinical Excellence (NICE) is a part of the NHS. Part of its work is the development of clinical guidelines. The Institute produces guidance for both the NHS and patients on best practice in the treatment of specific clinical areas and is developed with groups that represent patients/carers and healthcare professionals.

9. The guidelines published today are part of the Institute's Inherited Clinical Guidelines work programme. They were commissioned by the Department of Health before the Institute was formed in April 1999 and have followed closely the development brief that was agreed at the time of commissioning. The developers have worked with the Institute to ensure, in the time available, that the guideline has been subjected to validation and to consultation with stakeholders. However it has not been possible to subject them to the full guideline development process that the Institute has now adopted.

10. Health professionals are expected to take the Institute's guidance fully into account when exercising their clinical judgement for individual patients. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual woman in labour, in consultation with her and, where appropriate and necessary, her guardian or carer.