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

Autor: Mdoe PF; Haydom Lutheran Hospital, Mbulu, Tanzania. pfmdoe@gmail.com.; Department of Health Science, University of Stavanger, Stavanger, Norway. pfmdoe@gmail.com.; Obstetrics and Gynaecology, Haydom Lutheran Hospital, PO box 9000, Haydom, Mbulu, Tanzania. pfmdoe@gmail.com., Ersdal HL; Department of Health Science, University of Stavanger, Stavanger, Norway.; Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway., Mduma ER; Haydom Lutheran Hospital, Mbulu, Tanzania.; Department of Health Science, University of Stavanger, Stavanger, Norway., Perlman JM; Department of Pediatrics, Weill Cornell, New York, USA., Moshiro R; Department of Health Science, University of Stavanger, Stavanger, Norway.; Muhimbili National Hospital, Dar es Salaam, Tanzania., Wangwe PT; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania., Kidanto H; Department of Research, Stavanger University Hospital, Stavanger, Norway.; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Jazyk: angličtina
Zdroj: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2018 May 04; Vol. 18 (1), pp. 134. Date of Electronic Publication: 2018 May 04.
DOI: 10.1186/s12884-018-1746-9
Abstrakt: 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 .
Databáze: MEDLINE
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