Intermittent auscultation (IA) of fetal heart rate in labour for fetal well-being

Martis, Ruth; Emilia, Ova; Nurdiati, Detty Siti; Brown, Julie

doi:10.1002/14651858.cd008680.pub2

Cited by 41 publications

(29 citation statements)

References 45 publications

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“…Short-term outcomes include stillbirth, low Apgar score, need for resuscitations, neonatal intensive care unit admissions, and early neonatal deaths. 6 Long-term outcomes include cognitive and behavioral disabilities – affecting perhaps as much as one million children each year. 7 , 8 A focus on high coverage of good quality care during birth, including timely identification and rescue of the fetus from intrapartum hypoxia, 9 will save the lives of many newborns.…”

Section: Introductionmentioning

confidence: 99%

Intrapartum fetal heart rate monitoring using a handheld Doppler versus Pinard stethoscope: a randomized controlled study in Dar es Salaam

Kamala¹,

Kidanto²,

Wangwe³

et al. 2018

IJWH

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BackgroundFetal stethoscopes are mainly used for intermittent monitoring of fetal heart rate (FHR) during labor in low-income countries, where perinatal mortality is still high. Handheld Dopplers are rarely available and are dependent on batteries or electricity. The objective was to compare the Pinard stethoscope versus a new wind-up handheld Doppler in the detection of abnormal FHR.Materials and methodsWe conducted a randomized controlled study at Muhimbili National Hospital, Tanzania, from April 2013 to September 2015. Women with gestational age ≥37 weeks, cephalic presentation, normal FHR on admission, and cervical dilatation <7 cm were included. Primary outcome was abnormal FHR detection (<120 or >160 beats/min). Secondary endpoints were time to delivery, mode of delivery, and perinatal outcomes. χ2, Fisher’s exact test, Mann–Whitney test, and logistic regression were conducted. Unadjusted and adjusted odds ratios were calculated with respective 95% confidence interval.ResultsIn total, 2,844 eligible women were assigned to FHR monitoring with Pinard (n=1,423) or Doppler (n=1,421). Abnormal FHRs were more often detected in the Doppler (6.0%) versus the Pinard (3.9%) arm (adjusted odds ratio =1.59, 95% confidence interval: 1.13–2.26, p=0.008). Median (interquartile range) time from abnormal FHR detection to delivery was comparable between Doppler and Pinard, ie, 80 (60,161) and 89 (52,165) minutes, respectively, as was the incidence of cesarean delivery (12.0% versus 12.2%). The incidence of adverse perinatal outcomes (fresh stillbirths, 24-hour neonatal admissions, and deaths) was similar overall; however, among newborns with abnormal FHR delivered vaginally, adverse outcomes were less incident in Doppler (7 of 43 births, 16.3%) than in the Pinard arm (10 of 23 births, 43.5%), p=0.021.ConclusionIntermittent FHR monitoring using Doppler was associated with an increased detection of abnormal FHR compared to Pinard in a low-risk population. Time intervals from abnormal FHR detection to delivery were longer than recommended in both arms. Perinatal outcomes were better among vaginally delivered newborns with detected abnormal FHR in the Doppler arm.

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Section: Introductionmentioning

confidence: 99%

Intrapartum fetal heart rate monitoring using a handheld Doppler versus Pinard stethoscope: a randomized controlled study in Dar es Salaam

Kamala¹,

Kidanto²,

Wangwe³

et al. 2018

IJWH

View full text Add to dashboard Cite

show abstract

“…Auscultation with a fetal stethoscope, and occasionally with a fetal Doppler, are often the only method of fetal monitoring available in many low-resource settings [ 22 , 23 ]. In high-resource countries, cardiotocograph (CTG) is used, but complexities including high cost and need to continuous electricity supply limit use in low-resource settings [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of a novel continuous fetal Doppler (Moyo) improves quality of intrapartum fetal heart rate monitoring in a resource-limited tertiary hospital in Tanzania: An observational study

et al. 2018

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BackgroundIntrapartum Fetal Heart Rate (FHR) monitoring is crucial for the early detection of abnormal FHR, facilitating timely obstetric interventions and thus the potential reduction of adverse perinatal outcomes. We explored midwifery practices of intrapartum FHR monitoring pre and post implementation of a novel continuous automatic Doppler device (the Moyo).MethodologyA pre/post observational study among low-risk pregnancies at a tertiary hospital was conducted from March to December 2016. In the pre-implementation period, intermittent monitoring was conducted with a Pinard stethoscope (March to June 2016, n = 1640 women). In the post-implementation period, Moyo was used for continuous FHR monitoring (July-December 2016, n = 2442 women). The primary outcome was detection of abnormal FHR defined as absent, FHR<120or FHR>160bpm. The secondary outcomes were rates of assessment/documentation of FHR, obstetric time intervals and intrauterine resuscitations. Chi-square test, Fishers exact test, t-test and Mann-Whitney U test were used in bivariate analysis whereas binary and multinomial logistic regression were used for multivariate.ResultsMoyo use was associated with greater detection of abnormal FHR (8.0%) compared with Pinard (1.6%) (p<0.001). There were higher rates of non-assessment/documentation of FHR pre- (45.7%) compared to post-implementation (2.2%) (p<0.001). At pre-implementation, 8% of deliveries had FHR documented as often as ≤ 60 minutes, compared to 51% post-implementation (p<0.001). Implementation of continuous FHR monitoring was associated with a shorter time interval from the last FHR assessment to delivery i.e. median (IQR) of 60 (30,100) to 45 (21,85) minutes (p<0.001); and shorter time interval between each FHR assessment i.e. from 150 (86,299) minutes to 60 (41,86) minutes (p<0.001). Caesarean section rates increased from 2.6 to 5.4%, and vacuum deliveries from 2.2 to 5.8% (both p<0.001). Perinatal outcomes i.e. fresh stillbirths and early neonatal deaths were similar between time periods. The study was limited by both lack of randomization and involvement of low-risk pregnant women with fewer adverse perinatal outcomes than would be expected in a high-risk population.ConclusionImplementation of the Moyo device, which continuously measures FHR, was associated with improved quality in FHR monitoring practices and the detection of abnormal FHR. These improvements led to more frequent and timely obstetric responses. Follow-up studies in a high-risk population focused on a more targeted description of the FHR abnormalities and the impact of intrauterine resuscitation is a critical next step in determining the effect on reducing perinatal mortality.

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“…found that fetal heart rate (FHR) abnormalities detected during labor are associated with fresh stillbirth, low Apgar scores, and neonatal deaths . FHR monitoring during labor is the gold standard for facilitating improved fetal and neonatal outcomes . Proper and adequate monitoring of FHR using sensitive and reliable devices, coupled with timely and appropriate obstetric responses, can dramatically reduce the incidence of intrapartum‐related hypoxia, FSB, and neonatal deaths…”

Section: Introductionmentioning

confidence: 99%

Randomized controlled trial of continuous Doppler versus intermittent fetoscope fetal heart rate monitoring in a low‐resource setting

Mdoe

Ersdal

Mduma

et al. 2018

Intl J Gynecology & Obste

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Intermittent auscultation (IA) of fetal heart rate in labour for fetal well-being

Abstract: Intermittent auscultation (IA) of fetal heart rate in labour for fetal well-being.

Cited by 41 publications

References 45 publications

Intrapartum fetal heart rate monitoring using a handheld Doppler versus Pinard stethoscope: a randomized controlled study in Dar es Salaam

Intrapartum fetal heart rate monitoring using a handheld Doppler versus Pinard stethoscope: a randomized controlled study in Dar es Salaam

Implementation of a novel continuous fetal Doppler (Moyo) improves quality of intrapartum fetal heart rate monitoring in a resource-limited tertiary hospital in Tanzania: An observational study

Randomized controlled trial of continuous Doppler versus intermittent fetoscope fetal heart rate monitoring in a low‐resource setting

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