Abiana Patton-Toure
MDWF 2080
Assignment 1.2
IA and EFM
Intermittent Auscultation and Electronic Fetal Monitoring
Comparison
Intermittent Auscultation (IA)
Electronic Fetal Monitoring
(EFM)
Definition
Using a device (such as a
Pinard horn, fetoscope or
Doppler) to listen to fetal
heart rate for short durations
periodically. The sounds must
be interpreted by the listener.
Continuous monitoring of
uterine activity and FHR via
electronic probes strapped to
the mother’s abdomen or
inserted internally
Overview of the Research
● IA is the
recommended choice
for women with no
risk factors for fetal
hypoxia
● Frequency of listening
should be increased in
the second stage
● There aren’t
standardized
guidelines on the
frequency of listening
throughout the
different stages of
labor
● Majority of guidelines
recommend listening
after a contraction,
while some also
recommend listening
during and towards
the end of the
contractions
● Guidelines
recommend listening
for 30-60 seconds
● There is no significant
improvement in
outcome for the baby
by using EFM during
labor for low-risk
pregnancies
● Poor predictor of fetal
compromise
● Women are more
likely to feel their
movements are
restricted by EFM
Associated Outcomes
● Increased vaginal birth
rates
● Increased level of
intervention
● Lower neonatal
admission to NICUs
○ Epidural
○ Fetal blood
sampling
● Increase in operative
and assisted delivery
rates
● Does not reduce
perinatal mortality or
the incidence of
cerebral palsy
When they shouldn’t be used
● When the fetus is atrisk for fetal hypoxia
○ Suspected
maternal
infection
● Non-reassuring FHT
heard
● Against the mother’s
wishes
● When there isn’t a
clear indication for it
● Against the mother’s
wishes
Risks
● Heart tones must be
interpreted by the
listener
● Many practitioners
may not listen long
enough to get an
accurate rate
● Cannot detect decels,
accelerations or
variability
● May not be heard by
all people present
● Lower detection rates
of fetal distress
● Low specificity
(ability to identify
fetuses that aren’t
distressed)
● Poor predictive value
of adverse fetal
outcomes
● High rate of error
● Falsely identifies
“fetal distress”
● May induce medical
or non-medical
anxiety
● Presents a physical
barrier to “hands on”
support during labor
● Limits mobility
● Diminishes a woman’s
confidence in her
ability to safely give
birth without
technology
● Low risk
● Cannot typically
● Linked to reduction in
neonatal seizures
Benefits
interpret decels, acels
or variability
● Provides freedom of
movement
Who is a candidate
● Low-risk clients for
labor and birth
complications
● Suspected maternal or
fetal infection
● Long ROM
● GBS+ (esp. if
declining antibiotics)
● Placenta previa or any
other suspected
placental issues
● Those who IA is not
suitable for (potential
high BMIs where FHT
cannot be heard
easily)
● Confined clients
● Clients who prefer the
reassurance of EFM
● Clients with hx of
PTB, infection, short
cervix, pre or post
term babies
● Fetuses at-risk for or
with known specific
genetic defects (i.e
congenital heart
defects)
Additional research
● There is a lack of clear
evidence to guide the
frequency of IA
●