Clinical algorithms for management of fetal heart rate abnormalities during labour

Cheung, KW; Bonet, Mercedes; Frank, Karlyn; Oladapo, Olufemi T.; Hofmeyr, G Justus

doi:10.1111/1471-0528.16731

Cited by 3 publications

(1 citation statement)

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“…Additionally, a recent study evaluated FHR close to the time of delivery and showed that the baseline FHR decreases significantly toward the time of delivery [ 15 ]. However, the latest study did not take into account the mode of delivery, even though changes in FHR are known to influence the mode of delivery [ 16 ]. There is a need to specifically describe how FHR changes during the second stage and up to the moment of delivery in normal vaginal deliveries.…”

Section: Introductionmentioning

confidence: 99%

Fetal to Neonatal Heart Rate Transition during Normal Vaginal Deliveries: A Prospective Observational Study

et al. 2023

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Documentation of fetal to neonatal heart rate (HR) transition is limited. The aim of the current study was to describe HR changes from one hour before to one hour after normal vaginal deliveries. We conducted a prospective observational cohort study in Tanzania from 1 October 2020 to 30 August 2021, including normal vaginal deliveries with normal neonatal outcomes. HR was continuously recorded from one hour before to one hour after delivery, using the Moyo fetal HR meter, NeoBeat newborn HR meter, and the Liveborn Application for data storage. The median, 25th, and 75th HR percentiles were constructed. Overall, 305 deliveries were included. Median (interquartile range; IQR) gestational age was 39 (38–40) weeks and birthweight was 3200 (3000–3500) grams. HR decreased slightly during the last 60 min before delivery from 136 (123,145) to 132 (112,143) beats/minute. After delivery, HR increased within one minute to 168 (143,183) beats/min, before decreasing to around 136 (127,149) beats/min at 60 min after delivery. The drop in HR in the last hour of delivery reflects strong contractions and pushing. The rapid increase in initial neonatal HR reflects an effort to establish spontaneous breathing.

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Section: Introductionmentioning

confidence: 99%

Fetal to Neonatal Heart Rate Transition during Normal Vaginal Deliveries: A Prospective Observational Study

et al. 2023

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Clinical algorithms for identification and management of delay in the progression of first and second stage of labour

Pasquale

Chamillard

Díaz

et al. 2022

BJOG

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AimTo develop clinical algorithms for the assessment and management of slow progress of labour.PopulationLow‐risk singleton, term, pregnant women in labour.SettingInstitutional births in low‐ and middle‐income countries.Search strategyWe systematically reviewed the literature on normal labour progression, and guidance on clinical management of abnormally slow progression from 1 December 2015 to 1 October 2020 from relevant international guidelines, Cochrane reviews and primary research studies in PubMed by searching for international and national guidance documents, electronic databases and published systematic reviews using relevant keywords.Case scenariosWe developed two clinical algorithms: one for abnormally slow labour progression and arrest during first stage and one for the second stage. The algorithms provide definitions of suspected and confirmed slow progress of labour or arrest, initial assessment and ongoing monitoring, differential diagnosis, and management of the abnormalities, as well as links to other algorithms for labour management.ConclusionsIdentifying abnormal progress of labour is often challenging. These algorithms may help healthcare providers identify abnormal labour progress and institute prompt management or referral where needed but also reduce misdiagnosis and unnecessary use of interventions to accelerate labour.Tweetable abstractEvidence‐based clinical algorithms may help and standardize early identification and management of abnormally slow labour progress or arrest.

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Comparison of the effect of oral and vaginal misoprostol on labor induction: updating a systematic review and meta-analysis of interventional studies

et al. 2023

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Objectives This study is aimed to compare the effect of oral misoprostol with vaginal misoprostol to induce labor as a systematic review and meta-analysis. Methods Electronic databases including PubMed [Medline], Scopus, Web of science, Embase, Ovid, Cochrane library, and ClinicalTrials.gov were searched using the relevant keywords. All RCTs comparing the effect of oral vs vaginal misoprostol on labor induction were considered. The Cochrane Risk of Bias checklist was used for assessing quality of included RCTs. All statistical analyses were completed using STATA (Version 16) and Revman (Version 5). Results Thirty-three RCTs with 5162 patients (1560 in oral and 2602 in vaginal groups) were included in this meta-analysis. Labor induction length did differ significantly between the two routes of misoprostol administration [Standardized Mean Difference: 0.40 h, 95% confidence interval (CI) 0.34, 0.46; I2: 66.35%; P = 0.04]. In addition, the risk of neonatal death, tachysystole, uterine hyperstimulation, preeclampsia, non-FHR and abortion was lower in the oral misoprostol group and the risk of hypertonus, PROM, oxytocin need and cesarean fever was higher in this group than the vaginal misoprostol group. Conclusions Based on results of this meta-analysis, it can be inferred that currently, clinical specialists can decide to use this drug orally or vaginally on a case-by-case basis, depending on the condition of the pregnant mother and the baby.

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Clinical algorithms for management of fetal heart rate abnormalities during labour

Cited by 3 publications

References 50 publications

Fetal to Neonatal Heart Rate Transition during Normal Vaginal Deliveries: A Prospective Observational Study

Fetal to Neonatal Heart Rate Transition during Normal Vaginal Deliveries: A Prospective Observational Study

Clinical algorithms for identification and management of delay in the progression of first and second stage of labour

Comparison of the effect of oral and vaginal misoprostol on labor induction: updating a systematic review and meta-analysis of interventional studies

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