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Reducing Overuse and Underuse

Continuous External Fetal Heart Rate Monitoring During Labor

MaryAnn Dakkak, MD, MPH
Dominique Sanchez, MD
Helen Haskell
John James

American Family Physician. 2026;113(3):275-276.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

MARYANN DAKKAK, MD, MPH, Boston Medical Center, Boston, Massachusetts

DOMINIQUE SANCHEZ, MD, Adams Memorial Hospital, Decatur, Indiana

Address correspondence to MaryAnn Dakkak, MD, MPH, at maryann.dakkak@bmc.org.

Author disclosure: No relevant financial relationships.

  1. 1.ACOG Committee Opinion No. 766: approaches to limit intervention during labor and birth. Obstet Gynecol. 2019;133(2):e164-e173.
  2. 2.Alfirevic Z, Devane D, Gyte GM, et al. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2017(2):CD006066.
  3. 3.Haverkamp AD, Thompson HE, McFee JG, et al. The evaluation of continuous fetal heart rate monitoring in high-risk pregnancy. Am J Obstet Gynecol. 1976;125(3):310-20.
  4. 4.Al Wattar BH, Honess E, Bunnewell S, et al. Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes: a systematic review and network meta-analysis. CMAJ. 2021;193(14):E468-E477.
  5. 5.Kietpeerakool C, Lumbiganon P, Laopaiboon M, et al. Pregnancy outcomes of women with previous caesarean sections: secondary analysis of World Health Organization Multicountry Survey on Maternal and Newborn Health. Sci Rep. 2019;9(1):9748.
  6. 6.Bahl R, Hotton E, Crofts J, et al. Assisted vaginal birth in 21st century: current practice and new innovations. Am J Obstet Gynecol. 2024;230(3S):S917-S931.
  7. 7.Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2002. Natl Vital Stat Rep. 2003;52(10):1-113.
  8. 8.Heelan L. Fetal monitoring: creating a culture of safety with informed choice. J Perinat Educ. 2013;22(3):156-165.
  9. 9.De Vries RG, Low LK, Chuey M, et al. When evidence fails to change practice: examining the persistence of continuous fetal monitoring. Qual Health Res. 2025 ; 10497323251347137.
  10. 10.Kliff S. The ‘worst test in medicine’ is driving America's high C-section rate. New York Times. November 6, 2025. Updated November 10, 2025. Accessed Nov. 20, 2025. https://www.nytimes.com/2025/11/06/health/electronic-fetal-monitoring-c-sections.html

Lown Institute Right Care Alliance is a grassroots coalition of clinicians, patients, and community members organizing to make health care institutions accountable to communities and to put patients, not profits, at the heart of health care.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Lown Right Care published in AFP is available at https://www.aafp.org/afp/rightcare.

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