Fetal heart monitor doppler trial#

Fetal heart monitor doppler trial#

We undertook this randomised controlled trial at St. We aimed to use a randomised trial design to compare the primary screening methods of FHR monitoring (Doppler as intervention vs Pinard as standard of care) on incidence of detection of FHR abnormalities, and on the incidence of intrapartum stillbirth and neonatal mortality in the first 24вЂ…h after delivery. A single study by Mahomed et al 14 using a monitoring protocol of 10вЂ…min every half-hour found higher detection of FHR abnormalities and better perinatal outcomes in the intermittent auscultation Doppler group compared with the Pinard group. While there have been several studies showing reduced intervention and no improved outcomes in the use of the intermittent (Pinard or Doppler) versus continuous cardiotocography (CTG) monitoring as the primary screening tool in uncomplicated deliveries, 6 13 there is little research on outcomes in intermittent monitoring comparing Doppler versus Pinard. 11 12 It uses a hand crank to generate 2:30вЂ…min of use for every 30вЂ…s of cranking.

8 10 A rugged, wind-up, handheld Doppler FHR monitor (Doppler), developed by Power-free Education Technology (Pet.og.za) showed, in initial field tests, to be accurate and acceptable to mothers as well as midwives in low-resource settings. However, it permits the midwife to quickly locate the FHR, allows others, including the mother-to-be, to hear the FHR and permits her to remain in any comfortable position while being assessed, permits the midwife to assess the FHR as well as communicate to the woman the status of her baby, and has been shown to be preferred by women over the use of the Pinard. It requires a reliable power source and may need repairs, and is more costly than a Pinard. The handheld Doppler ultrasound FHR monitor (Doppler) detects FHR and provides a steady state number per minute, as well as audible auscultation of the FHR.

In addition, the midwife usually counts the FHR for a short time, for example, 15вЂ…s, and multiplies to reach bpm, further decreasing accuracy and introducing calculation errors. The reading can be unreliable in obese women, and it requires the midwife to place her ear in close proximity to the womanвЂ™s pubic area. It requires additional time to precisely locate the fetal heart as the heart is only audible within a very narrow area of the womanвЂ™s abdomen it requires that the surrounding area be quiet in order to hear the fetal heart. The difficulties posed in using a Pinard are generally not conducive to a busy labour ward. 6вЂ“9 One method of intermittent auscultation uses the Pinard Fetal Stethoscope (Pinard), a trumpet shaped horn, to monitor the FHR, and is widely adopted as the standard of care in resource-poor settings since it is low cost and does not require a power source or repairs. 5 Intermittent auscultation as a primary screening tool to monitor fetal well-being is the recommended standard of care for women experiencing uncomplicated deliveries.

4 In order to reduce the incidence of intrapartum-related stillbirths and neonatal deaths, it is necessary to assess fetal well-being in labour with routine monitoring of the fetal heart rate (FHR), linked to rapid and effective management with resuscitative measures or prompt delivery, and provision of neonatal resuscitation if needed.Д¬haracteristic FHR changes often precede brain injury via a process of progressive fetal hypoxic acidaemia. 3 This burden is highest in areas of the world where the probability of quality of care at birth is the lowest.

2 There are also an estimated 1.02 million intrapartum stillbirths, almost all in low-income and middle-income countries. 1 The third largest cause of neonatal mortality is intrapartum-related hypoxia (formerly called вЂbirth asphyxiaвЂ™) resulting in an estimated 660вЂ…000 neonatal deaths per year globally 1 and an additional 414вЂ…000 children who survive with disability. Approximately, 44% of all child deaths under the age of 5вЂ…years occur in neonates (<28вЂ…days of age).