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

Mdoe, Paschal; Ersdal, Hege; Mduma, Estomih; Moshiro, Robert; Dalen, Ingvild; Perlman, Jeffrey M.; Kidanto, Hussein

doi:10.1002/ijgo.12648

Cited by 25 publications

(60 citation statements)

References 16 publications

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“…Although this approach underreports the problem, the findings highlight the challenge of adhering to guidelines in these settings. In other resource-limited settings of Sub-Saharan Africa, randomised control trials on innovative FHRM devices failed to show improvement in perinatal outcomes due Values are given as mean (standard deviation) *Significant level at 0.05: there were less senior doctors in the evening and night, and less intern doctors at night compared to morning shifts to non-adherence to FHRM international guidelines and obstetric response [21][22][23][24]. In this hospital, international guidelines were adapted to locally-acceptable minimum standards [9].…”

Section: Discussionmentioning

confidence: 99%

Quality of intrapartum care: direct observations in a low-resource tertiary hospital

et al. 2020

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Background: The majority of the world's perinatal deaths occur in low-and middle-income countries. A substantial proportion occurs intrapartum and is avoidable with better care. At a low-resource tertiary hospital, this study assessed the quality of intrapartum care and adherence to locally-tailored clinical guidelines. Methods: A non-participatory, structured, direct observation study was held at Mnazi Mmoja Hospital, Zanzibar, Tanzania, between October and November 2016. Women in active labour were followed and structure, processes of labour care and outcomes of care systematically recorded. Descriptive analyses were performed on the labour observations and compared to local guidelines and supplemented by qualitative findings. A Poisson regression analysis assessed factors affecting foetal heart rate monitoring (FHRM) guidelines adherence. Results: 161 labouring women were observed. The nurse/midwife-to-labouring-women ratio of 1:4, resulted in doctors providing a significant part of intrapartum monitoring. Care during labour and two-thirds of deliveries was provided in a one-room labour ward with shared beds. Screening for privacy and communication of examination findings were done in 50 and 34%, respectively. For the majority, there was delayed recognition of labour progress and insufficient support in second stage of labour. While FHRM was generally performed suboptimally with a median interval of 105 (interquartile range 57-160) minutes, occurrence of an intrapartum risk event (non-reassuring FHR, oxytocin use or poor progress) increased assessment frequency significantly (rate ratio 1.32 (CI 1.09-1.58)). Conclusions: Neither international nor locally-adapted standards of intrapartum routine care were optimally achieved. This was most likely due to a grossly inadequate capacity of birth attendants; without whom innovative interventions at birth are unlikely to succeed. This calls for international and local stakeholders to address the root causes of unsafe intrafacility care in low-resource settings, including the number of skilled birth attendants required for safe and respectful births.

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Section: Discussionmentioning

confidence: 99%

Quality of intrapartum care: direct observations in a low-resource tertiary hospital

et al. 2020

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“…In another RCT in Tanzania, an increase in risk of intrauterine resuscitation was observed for women continuously monitored with Doppler as compared with those intermittently monitored with Pinard (RR, 2.07; 95% CI, 1.4-2.9); as described above, there was no difference in adverse perinatal outcomes between the two arms. 20 In Tanzania, two RCTs of intermittent monitoring with Doppler versus intermittent monitoring with Pinard did not find a difference in time from abnormal FHR detection to delivery between the two arms. 17,18 In Zimbabwe, there was no difference in mean duration of labor among the four study groups.…”

Section: Findings On Clinical Management Associated With Abnormal Fhrmentioning

confidence: 94%

“…Six studies addressed the effectiveness of Doppler versus Pinard stethoscope for the detection of abnormal FHR during intermittent or continuous FHR monitoring in the intrapartum period (Table 1). [15][16][17][18][19][20] Freeplay (wind-up) Doppler, 17 Moyo strap-on Doppler using the continuous or intermittent monitoring function, 18,19 and the Huntleigh pocket Doppler. 15…”

Section: Fhr Abnormalities and Adverse Perinatal Outcomesmentioning

confidence: 99%

Systematic review of Doppler for detecting intrapartum fetal heart abnormalities and measuring perinatal mortality in low‐ and middle‐income countries

Plotkin

Kamala

Ricca

et al. 2019

Intl J Gynecology & Obste

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Background: Using Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalities coupled with appropriate, timely intrapartum care in low-and middleincome countries (LMIC) can save lives. Objective:To review studies using Doppler to improve detection of intrapartum FHR abnormalities and intrapartum care quality in LMIC health facilities. Search strategy: PubMed, Web of Science, Embase, Global Health, and Scopus were searched from inception to October 2018 by combining terms for Doppler, perinatal outcomes, and FHR monitoring. Selection criteria: Selected studies compared Doppler and Pinard stethoscope for detecting/monitoring intrapartum FHR, or described provider and maternal preferences for FHR monitoring in LMIC settings. Data collection and analysis: Two team members independently screened and collected data. Risk of bias was assessed by Cochrane EPOC criteria. Results: Eleven studies from eight countries were included. Doppler was superior at detecting abnormal intrapartum FHR as compared with Pinard stethoscope, but was not associated with improved perinatal outcomes. Using Doppler on admission helped to accurately measure perinatal deaths occurring after facility admission. Conclusion: Studies and program learning are needed to translate improved detection of FHR abnormalities to improved case management in LMICs. Doppler should be used to calculate a facility indicator of intrapartum care quality. PROSPERO registration: CRD42019121924.

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“…As part of the Safer Births project, a randomized controlled study, carried out in rural settings in Tanzania, revealed that the use of Moyo increased the identification of baseline abnormal FHR and subsequent intrauterine resuscitations. 66 Further, qualitative studies on the preferences and acceptability of the strap-on Moyo device among mothers and clinical staff have been conducted. The findings of these studies show that preference and acceptance was high compared to other devices.…”

Section: Safer Births Project and The Development Of An Automatic Strmentioning

confidence: 99%

“…69 The second study compared the Moyo with the Pinard method and showed that the use of Moyo increased FHR detection and intrapartum resuscitations compared to the Pinard with similar perinatal outcomes. 66…”

Section: Current Fhr Monitoring Practicesmentioning

confidence: 99%

Assessment of foetal heart rate monitoring devices in referral hospitals in Tanzania: Towards improved quality of intrapartum care

Kamala¹

2020

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

Abstract: Continuous FHR monitoring increased identification of abnormal FHR and subsequent intrauterine resuscitations. ClinicalTrials.gov: NCT02790814.

Cited by 25 publications

References 16 publications

Quality of intrapartum care: direct observations in a low-resource tertiary hospital

Quality of intrapartum care: direct observations in a low-resource tertiary hospital

Systematic review of Doppler for detecting intrapartum fetal heart abnormalities and measuring perinatal mortality in low‐ and middle‐income countries

Assessment of foetal heart rate monitoring devices in referral hospitals in Tanzania: Towards improved quality of intrapartum care

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