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

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 h...

Full description

Bibliographic Details
Main Authors:	Paschal Francis Mdoe, Hege L. Ersdal, Estomih R. Mduma, Jeffrey M. Perlman, Robert Moshiro, Peter T. Wangwe, Hussein Kidanto
Format:	Article
Language:	English
Published:	BioMed Central 2018-05-01
Series:	BMC Pregnancy and Childbirth
Subjects:	Intermittent fetal heart rate monitoring Pinard fetoscope Doppler
Online Access:	http://link.springer.com/article/10.1186/s12884-018-1746-9

id	doaj-art-6d1652725f7b4dfc8da44a016724f260
recordtype	oai_dc
spelling	doaj-art-6d1652725f7b4dfc8da44a016724f2602018-08-15T23:53:43ZengBioMed CentralBMC Pregnancy and Childbirth1471-23932018-05-011811810.1186/s12884-018-1746-9Intermittent fetal heart rate monitoring using a fetoscope or hand held Doppler in rural Tanzania: a randomized controlled trialPaschal Francis Mdoe0Hege L. Ersdal1Estomih R. Mduma2Jeffrey M. Perlman3Robert Moshiro4Peter T. Wangwe5Hussein Kidanto6Haydom Lutheran HospitalDepartment of Health Science, University of StavangerHaydom Lutheran HospitalDepartment of PediatricsDepartment of Health Science, University of StavangerMuhimbili University of Health and Allied SciencesDepartment of Research, Stavanger University HospitalAbstract 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.http://link.springer.com/article/10.1186/s12884-018-1746-9Intermittent fetal heart rate monitoringPinard fetoscopeDoppler
institution	Open Data Bank
collection	Open Access Journals
building	Directory of Open Access Journals
language	English
format	Article
author	Paschal Francis Mdoe Hege L. Ersdal Estomih R. Mduma Jeffrey M. Perlman Robert Moshiro Peter T. Wangwe Hussein Kidanto
spellingShingle	Paschal Francis Mdoe Hege L. Ersdal Estomih R. Mduma Jeffrey M. Perlman Robert Moshiro Peter T. Wangwe Hussein Kidanto Intermittent fetal heart rate monitoring using a fetoscope or hand held Doppler in rural Tanzania: a randomized controlled trial BMC Pregnancy and Childbirth Intermittent fetal heart rate monitoring Pinard fetoscope Doppler
author_facet	Paschal Francis Mdoe Hege L. Ersdal Estomih R. Mduma Jeffrey M. Perlman Robert Moshiro Peter T. Wangwe Hussein Kidanto
author_sort	Paschal Francis Mdoe
title	Intermittent fetal heart rate monitoring using a fetoscope or hand held Doppler in rural Tanzania: a randomized controlled trial
title_short	Intermittent fetal heart rate monitoring using a fetoscope or hand held Doppler in rural Tanzania: a randomized controlled trial
title_full	Intermittent fetal heart rate monitoring using a fetoscope or hand held Doppler in rural Tanzania: a randomized controlled trial
title_fullStr	Intermittent fetal heart rate monitoring using a fetoscope or hand held Doppler in rural Tanzania: a randomized controlled trial
title_full_unstemmed	Intermittent fetal heart rate monitoring using a fetoscope or hand held Doppler in rural Tanzania: a randomized controlled trial
title_sort	intermittent fetal heart rate monitoring using a fetoscope or hand held doppler in rural tanzania: a randomized controlled trial
publisher	BioMed Central
series	BMC Pregnancy and Childbirth
issn	1471-2393
publishDate	2018-05-01
description	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.
topic	Intermittent fetal heart rate monitoring Pinard fetoscope Doppler
url	http://link.springer.com/article/10.1186/s12884-018-1746-9
_version_	1612699060785905664

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

Similar Items