Role of Fetal Vibroacoustic Stimulation Test as an Adjunct to Non-Reassuring Cardiotocography During Labour in Low-Resource Settings

Abstract

This randomized controlled trial (RCT) was undertaken to evaluate the effect of vibroacoustic stimulation (VAS) on the fetal heart rate tracing, mode of delivery and perinatal outcomes, when cardiotocographs (CTG) showed non-reassuring features during labour. In this RCT, 60 women beyond 30 weeks' gestation in labour having non reassuring CTG for 20 min were recruited in either study group (VAS group) or control group (non-VAS group). Women in the study group received VAS for 3 sec up to 3 occasions at an interval of 1 to 3 min while the control group received no VAS. There were significant improvement of baseline variability and acceleration in both VAS and control group during second 20 min (P<0.001). Although these improvements were more evident in VAS group, the difference between the two groups were not statistically significant (P>0.05). However, in VAS group, there was 3 min less testing time required to achieve reassuring CTG features (2.6 versus 5.6 min), and a tendency to have less cesarean delivery (60% versus 55.2%; p>0.05). Perinatal outcomes were similar in both groups. There is a trend toward less number of caesarean section in VAS group, probably because of early and more acquisition of reassuring CTG features. Therefore, this study suggests that VAS is potentially beneficial in women with suspicious CTG. Considering the procedure simple, safe and less expensive, it would be prudent to use VAS during CTG monitoring, especially in low resource countries, where facilities for fetal blood sampling is not widely available.

Cardiotocography use for fetal assessment during labor in low‐ and middle‐income countries: A scoping review

“…Table 1 provides the characteristics of the included studies. Our review identified eight intervention studies, including randomized controlled trials (RCTs) 12,13,18–20,23 and quasi‐experimental studies 17,22 ; and 59 observational studies, including cohort studies, 15,24–26,28–30,32,34,36–38,40,41,43,46,47,50,56–58,61,63,65–71,73–75,77,78 case–control studies, 27,33,35,39,42,44,45,48,49,52,53,55,62,64,72 before and after studies, 14,16,21,31 and cross‐sectional studies 51,54,60,76,79 . These studies were published between 1974 and 2023.…”

“…These were published between 2013 and 2022, and the studies included three RCTs, a quasi‐experimental study, and one before and after study. In this study, monitoring techniques included vibroacoustic stimulation, 19 CTG with a computerized decision support system, 20 fetal scalp blood sampling, 22 education package of fetal heart rate monitoring, 21 and fetal acoustic stimulation 23 . The majority of the 55 studies aimed at validating CTG waveform assessment methods were published between 1974 and 2023, and the studies included 34 cohort studies, 13 case control studies, six cross sectional study, a before and after study, and a nested case control study.…”

“…12,13,[16][17][18][19][20][21]23 Perinatal deaths were reported in half of the studies 12,[14][15][16][17]19,20 ; and in two studies, no events were observed in either group. Two studies reported meconium aspiration syndrome, 13,17 hypoxic encephalopathy, 13,19 and acidemia. 20,23…”

“…12,[15][16][17][18] The addition of other technologies to CTG tended to reduce the cesarean section rate more effectively than CTG alone. [20][21][22] Regarding other perinatal outcomes, eight studies reported on 5-min Apgar scores, 12,13,16,[18][19][20][21]23 and nine studies on NICU admissions. 12,13,[16][17][18][19][20][21]23 Perinatal deaths were reported in half of the studies 12,[14][15][16][17]19,20 ; and in two studies, no events were observed in either group.…”

“…[20][21][22] Regarding other perinatal outcomes, eight studies reported on 5-min Apgar scores, 12,13,16,[18][19][20][21]23 and nine studies on NICU admissions. 12,13,[16][17][18][19][20][21]23 Perinatal deaths were reported in half of the studies 12,[14][15][16][17]19,20 ; and in two studies, no events were observed in either group. Two studies reported meconium aspiration syndrome, 13,17 hypoxic encephalopathy, 13,19 and acidemia.…”