The grades of evidence (I-III) and levels of recommendations (A-C) are defined at the end of the "Major Recommendations" field
The following recommendations are based on good and consistent scientific evidence (Level A):
- The false-positive rate of electronic fetal monitoring (EFM) for predicting adverse outcomes is high.
- The use of EFM is associated with an increase in the rate of operative interventions (vacuum, forceps, and cesarean delivery).
- The use of EFM does not result in a reduction of cerebral palsy rates.
- With persistent variable decelerations, amnioinfusion reduces the need to proceed with emergent cesarean delivery and should be considered.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- The labor of parturients with high-risk conditions should be monitored continuously.
- Reinterpretation of the fetal heart rate (FHR) tracing, especially knowing the neonatal outcome, is not reliable.
- The use of fetal pulse oximetry in clinical practice cannot be supported at this time.
Definitions:
Grades of Evidence
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A — Recommendations are based on good and consistent scientific evidence.
Level B — Recommendations are based on limited or inconsistent scientific evidence.
Level C — Recommendations are based primarily on consensus and expert opinion.
