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Cerebral Palsy And The New ACOG Guidelines For Fetal Heart Monitoring

In the July issue of The Journal Of Obstetrics And Gynecology the American College of Obstetrics & Gynecology (“ACOG”) is rolling out its revised practice guideline for Fetal Heart Monitoring. According to the New York Times, the college hopes the new guidelines will do away with inconsistent interpretations and cause a reduction in the rate of caesarean sections, which is as high as 40% in cities like Chicago, New York and Philadelphia.

More then 85% of the more than four million babies born in the United States are subjected to continuous fetal heart monitoring. The force behind the revised ACOG guidelines, Dr. George Macones, a Washington University OB/GYN, believes that continuous fetal heart monitoring became the standard of care before studies could be done to show that the benefits of monitoring outweigh the risk of caesarian section. The college believes that fetal heart monitoring has caused a rise in caesarian section and forcep deliveries, is used by lawyers to bolster meritless malpractice claims and has not reduced the incidence of Cerebral Palsy and/or fetal death.

The new ACOG bulletin explains that the new guidelines do not affect the risk of Cerebral Palsy because more then 70% of Cerebral Palsy occurs due to factors that arise before labor and delivery. The new guidelines create three classifications of fetal heart tracings which depart from the traditional reassuring vs. non-reassuring dichotomy. The new categories are normal, indeterminate (not to be read as dangerous) requiring re-evaluation and abnormal. The college expects to further refine these guidelines in the coming years.

This is an interesting but not suprising change of position from ACOG. Fetal heart monitoring is, for the most part, non-invasive and risk free. Caesarian Section is one of the safest surgeries practiced in modern medicine. Cerebral Palsy is a devastating condition. Is the college motivated by providing better and safer care to its patients or protecting doctors from malpractice litigation which, they claim, has led to soaring malpractice premiums. Only time will tell.

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