BMJ 1994;308:497-500 (19 February)

Papers

Randomised controlled trial of intrapartum fetal heart rate monitoring

K Mahomed, R Nyoni, T Mulambo, J Kasule, E Jacobus 

University of Zimbabwe, Department of Obstetrics, PO Box A178, Avondale, Harare, Zimbabwe.

Abstract

Objective : To compare effectiveness of different methods of monitoring intrapartum fetal heart rate.
Design : Prospective randomised controlled trial.
Setting : Referral maternity hospital, Harare,Zimbabwe.
Subjects : 1255 women who were 37 weeks or more pregnant with singleton cephalic presentation and normal fetal heart rate before entry into study.
Interventions : Intermittent monitoring of fetal heart rate by electronic monitoring, Doppler ultrasound, use of Pinard stethoscope by a research midwife, or routine use of Pinard stethoscope by attending midwife. Main outcome measures - Abnormal fetal heart rate patterns, need for operative delivery for fetal distress, neonatal mortality, Apgar scores, admission to neonatal unit, neonatal seizures, and hypoxic ischaemic encephalopathy.
Results : Abnormalities in fetal heart rate were detected in 54% (172/318) of the electronic monitoring group, 32% (100/312) of the ultrasonography group, 15% (47/310) of the Pinard stethoscope group, and 9% (28/315) of the routine monitoring group. Caesarean sections were performed for 28% (89), 24% (76), 10% (32), and 15% (46) of the four groups respectively. Neonatal outcome was best in the ultrasonography group: hypoxic ischaemic encephalopathy occurred in two, one, seven, and 10 cases in the four groups respectively; neonatal seizures occurred only in the last two groups (six and nine cases respectively); and deaths occurred in eight,two, five, and nine cases respectively.
Conclusions : Abnormalities in fetal heart rate were more reliably detected by Doppler ultrasonography than with Pinard stethoscope, and its use resulted in good perinatal outcome. The use ofrelatively cheap ultrasound monitors should be further evaluated and promoted in obstetric units caring for high risk pregnancies in developing countries with scarce resources.

Clinical implications

  • Clinical implications

  • Intrapartum asphyxia is an important cause of perinatal mortality and morbidity, particularly in developing countries

  • As screening for asphyxia is dependent on detection of abnormalities in fetal heart rate, continuous electronic monitoring of fetal heart rate is thought to be appropriate for women in labour with a high risk of fetal hypoxia

  • This study compared the abilities of intermittent electronic monitoring, a hand held Doppler ultrasound monitor, and the Pinard stethoscope to detect abnormalities in fetal heart rate and their contribution to mode of delivery and fetal outcome.

  • The ultrasound monitor was better at detecting abnormalities in fetal heart rate than the Pinard stethoscope and was associated with lower neonatal morbidity and mortality, and perinatal outcome was no worse than that achieved with electronic monitoring

  • Doppler ultrasound monitoring should be promoted in developing countries where electronic monitoring is not feasible, and in first world countries ultrasonography should be evaluated as a possible alternative to electronic monitoring of fetal heart rate


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Relevant Article

Intrapartum monitoring in rural Africa
R V Millard
BMJ 1994 308: 720. [Extract] [Full Text]

This article has been cited by other articles:

  • Chalumeau, M., Bouvier-Colle, M.-H., Breart, G. (2002). Can clinical risk factors for late stillbirth in West Africa be detected during antenatal care or only during labour?. Int J Epidemiol 31: 661-668 [Abstract] [Full text]  
  • Millard, R V (1994). Intrapartum monitoring in rural Africa. BMJ 308: 720-720 [Full text]  
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