Randomised controlled trial of intrapartum fetal heart rate monitoring.
OBJECTIVE
To compare effectiveness of different methods of monitoring intrapartum fetal heart rate.


METHODS
Prospective randomised controlled trial.


METHODS
Referral maternity hospital, Harare, Zimbabwe.


METHODS
1255 women who were 37 weeks or more pregnant with singleton cephalic presentation and normal fetal heart rate before entry into study.


METHODS
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.


METHODS
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 of relatively cheap ultrasound monitors should be further evaluated and promoted in obstetric units caring for high risk pregnancies in developing countries with scarce resources.
Mahomed
K
K
University of Zimbabwe, Department of Obstetrics, Avondale, Harare.
Nyoni
R
R
Mulambo
T
T
Kasule
J
J
Jacobus
E
E
D005260:Female; D005323:Fetal Monitoring / Q000379:methods* / Q000592:standards; D006340:Heart Rate, Fetal; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D016216:Ultrasonography, Prenatal