Discussion Questions

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  Why is this topic important?

  
  
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  Might selection bias have affected this study?

  
  
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  Why is it important to identify the direction of potential bias?

  
  
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  What are the pros and cons of interpreting tracings with computer analysis?

  
  
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  Would you have included women who delivered by cesarean section?

  
  
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  Should we start using this 5-tier system in practice?

  
  
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  Are the authors’ conclusions congruent with their findings?

  
  
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  What are future directions for research?

It is no secret to obstetricians that intrapartum electronic fetal monitoring (EFM) is the most commonly used instrument in obstetrics. What continues to surprise us is the paucity of available data associating EFM patterns with clinically relevant outcomes, even though the technology is used daily to manage patients in labor.

While it is widely accepted that EFM has the potential to alert physicians to signs of fetal compromise, allowing timely intervention and the prevention of permanent neonatal morbidity, EFM must be investigated rigorously before this is proven to be true. Journal Club members said the research by Elliot et al highlighted the importance of further scrutiny and, specifically, the value of applying common nomenclature to EFM patterns and associating them with meaningful clinical outcomes.