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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Intermittent fetal heart rate monitoring using a fetoscope or hand held Doppler in rural Tanzania: a randomized controlled trial

Authors: Paschal Francis Mdoe, Hege L. Ersdal, Estomih R. Mduma, Jeffrey M. Perlman, Robert Moshiro, Peter T. Wangwe, Hussein Kidanto

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

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Abstract

Background

Neonatal mortality is a global challenge, with an estimated 1.3 million intrapartum stillbirths in 2015. The majority of these were found in low resource settings with limited options to intrapartum fetal heart monitoring devices. This trial compared frequency of abnormal fetal heart rate (FHR) detection and adverse perinatal outcomes (i.e. fresh stillbirths, 24-h neonatal deaths, admission to neonatal care unit) among women intermittently assessed by Doppler or fetoscope in a rural low-resource setting.

Methods

This was an open-label randomized controlled trial conducted at Haydom Lutheran Hospital from March 2013 through August 2015. Inclusion criteria were; women in labor, singleton, cephalic presentation, normal FHR on admission (120–160 beats/minute), and cervical dilatation ≤7 cm. Verbal consent was obtained.

Results

A total of 2684 women were recruited, 1309 in the Doppler and 1375 in the fetoscope arms, respectively. Abnormal FHR was detected in 55 (4.2%) vs 42 (3.1%). (RR = 1.38; 95%CI: 0.93, 2.04) in the Doppler and fetoscope arms, respectively. Bag mask ventilation was performed in 80 (6.1%) vs 82 (6.0%). (RR = 1.03; 95%CI: 0.76, 1.38) of neonates, and adverse perinatal outcome was comparable 32(2.4%) vs 35(2.5%). (RR = 0.9; 95%CI: 0.59, 1.54), in the Doppler and fetoscope arms, respectively.

Conclusion

This trial failed to demonstrate a statistically significant difference in the detection of abnormal FHR between intermittently used Doppler and fetoscope and adverse perinatal outcomes. However, FHR measurements were not performed as often as recommended by international guidelines. Conducting a randomized controlled study in rural settings with limited resources is associated with major challenges.

Trial registration

This clinical trial was registered on April 2013 with registration number NCT01869582.
Literature
1.
Oza S, Cousens SN, Lawn JE. Estimation of daily risk of neonatal death, including the day of birth, in 186 countries in 2013: a vital-registration and modelling-based study. Lancet Glob Heal. 2014;2(11):e635–44.CrossRef
2.
Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162–72.CrossRefPubMed
3.
Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;6736(15):1–17.
4.
Lawn JE, Kerber K, Enweronu-Laryea C, Bateman OM. Newborn survival in low resource settings - are we delivering? BJOG. 2009;116:49–59.CrossRefPubMed
5.
Unicef. Levels and trends in child mortality. New York: UNICEF; 2013. p. 1–30.
6.
Saleem S, McClure EM, Goudar SS, Patel A, Esamai F, Garces A, et al. A prospective study of maternal, fetal and neonatal deaths in low- and middle-income countries. Bull World Health Organ. 2014;92(8):605–12.CrossRefPubMedPubMedCentral
7.
Ersdal HL, Mduma E, Svensen E, Perlman J. Birth asphyxia: a major cause of early neonatal mortality in a Tanzanian rural hospital. Pediatrics. 2012;129(5):e1238–43.CrossRefPubMed
8.
Allanson ER, Muller M, Pattinson RC. Causes of perinatal mortality and associated maternal complications in a South African province: challenges in predicting poor outcomes. BMC Pregnancy Childbirth. 2015;15(1):37.CrossRefPubMedPubMedCentral
9.
Schmiegelow C, Minja D, Oesterholt M, Pehrson C, Suhrs HE, Boström S, et al. Factors associated with and causes of perinatal mortality in northeastern Tanzania. Acta Obstet Gynecol Scand. 2012;91(9):1061–8.CrossRefPubMed
10.
Hadar A, Sheiner E, Hallak M, Katz M, Mazor M, Shoham-Vardi I. Abnormal fetal heart rate tracing patterns during the first stage of labor: effect on perinatal outcome. Am J Obstet Gynecol. 2001;185:863–8.CrossRefPubMed
11.
Verspyck E, Sentilhes L. Abnormal fetal heart rate patterns associated with different labour managements and intrauterine resuscitation techniques. J Gynecol Obstet Biol Reprod (Paris). 2008;37(Suppl 1):S56–64.CrossRef
12.
Xu H, Mas-Calvet M, Wei SQ, Luo ZC, Fraser WD. Abnormal fetal heart rate tracing patterns in patients with thick meconium staining of the amniotic fluid: association with perinatal outcomes. Am J Obstet Gynecol. 2009;200(3):283.CrossRefPubMed
13.
Langli Ersdal H, Mduma E, Svensen E, Sundby J, Perlman J. Intermittent detection of fetal heart rate abnormalities identify infants at greatest risk for fresh stillbirths, birth asphyxia, neonatal resuscitation, and early neonatal deaths in a limited-resource setting: a prospective descriptive observational stud. Neonatology. 2012;102(3):235–42.CrossRefPubMed
14.
Alfirevic Z, Devane D, Gyte GML. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2006;3(3):81.
15.
16.
Mahomed K, Nyoni R, Mlambo T, Jacobus E, Kasule J. Intrapartum foetal heart rate monitoring--continuous electronic versus intermittent Doppler--a randomised controlled trial. Cent Afr J Med. 1992;38(12):458–62.PubMed
17.
Mangesi L, Hofmeyr GJH, Woods DL. Assessing the preference of women for different methods of monitoring the fetal heart in labour. S Afr J Obstet Gynaecol. 2009;15(2):58–9.
18.
19.
Woods D. Appropriate technology and education for improved intrapartum care in under- resourced countries; 2009. p. 78–9.
20.
Byaruhanga R, Bassani DG, Jagau A, Muwanguzi P, Montgomery AL, Lawn JE. Use of wind-up fetal Doppler versus Pinard for fetal heart rate intermittent monitoring in labour: a randomised clinical trial. BMJ Open. 2015;5(1):e006867.CrossRefPubMedPubMedCentral
21.
Evjen-Olsen B, Olsen OE, Kvåle G. Achieving progress in maternal and neonatal health through integrated and comprehensive healthcare services - experiences from a programme in northern Tanzania. Int J Equity Health. 2009;8:27.CrossRefPubMedPubMedCentral
22.
23.
Maaløe N, Housseine N, Meguid T, Nielsen BB, Jensen AKG, Khamis RS, et al. Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: a quasi-experimental pre-post study (the PartoMa study). BJOG An Int J Obstet Gynaecol. 2018;125(2):235–45.CrossRef
24.
Lewis D, Downe S. FIGO consensus guidelines on intrapartum fetal monitoring: intermittent auscultation. Int J Gynecol Obstet. Elsevier B.V. 2015;131(1):9–12.CrossRef
25.
Committee NH, Ayres-de-campos D, Spong CY, Chandraharan E. Figo consensus guidelines on intrapartum fetal monitoring; 2015. p. 1–7.
26.
Morrison JC, Chez BF, Davis ID, Martin RW, Roberts WE, Martin JN Jr, Floyd RC. Intrapartum fetal heart rate assessment: monitoring by auscultation or electronic means. Am J Obstet Gynecol. 1993;168(1 Pt 1):63–6.CrossRefPubMed
Metadata
Title
Intermittent fetal heart rate monitoring using a fetoscope or hand held Doppler in rural Tanzania: a randomized controlled trial
Authors
Paschal Francis Mdoe
Hege L. Ersdal
Estomih R. Mduma
Jeffrey M. Perlman
Robert Moshiro
Peter T. Wangwe
Hussein Kidanto
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1746-9

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