Since electronic fetal monitoring was introduced into clinical practice in the United States 4 decades ago, it has been a source of optimism, confusion, controversy, and cynicism. With increasing understanding of the technology's strengths and weaknesses, it has become necessary to adjust expectations. Contrary to early hopes, electronic fetal heart rate monitoring is not a reliable tool for diagnosing fetal hypoxic neurological injury, partially because of the relative rarity of intrapartum hypoxic neurological injury, partially because of the mitigating interventions frequently prompted by "abnormal" fetal heart rate patterns, and partially because fetal monitoring simply is not a diagnostic test. In contrast, fetal monitoring is a very reliable screening test for identifying a subset of fetuses at increased risk for hypoxic neurological injury. Most importantly, a normal fetal heart rate tracing is an extremely effective tool for excluding ongoing hypoxic injury.
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