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 study at Haydom Lutheran Hospital.
BACKGROUND
Intermittent fetal heart rate (FHR) monitoring during labor using an acoustic stethoscope is the most frequent method for fetal assessment of well-being in low- and middle-income countries. Evidence concerning reliability and efficacy of this technique is almost nonexistent.


OBJECTIVE
To determine the value of routine intermittent FHR monitoring during labor in the detection of FHR abnormalities, and the relationship of abnormalities to the subsequent fresh stillbirths (FSB), birth asphyxia (BA), need for neonatal face mask ventilation (FMV), and neonatal deaths within 24 h.


METHODS
This is a descriptive observational study in a delivery room from November 2009 through December 2011. Research assistants/observers (n = 14) prospectively observed every delivery and recorded labor information including FHR and interventions, neonatal information including responses in the delivery room, and fetal/neonatal outcomes (FSB, death within 24 h, admission neonatal area, or normal).


RESULTS
10,271 infants were born. FHR was abnormal (i.e. <120 or >160 beats/min) in 279 fetuses (2.7%) and absent in 200 (1.9%). Postnatal outcomes included FSB in 159 (1.5%), need for FMV in 695 (6.8%), BA (i.e. 5-min Apgar score <7) in 69 (0.7%), and deaths in 89 (0.9%). Abnormal FHR was associated with labor complications (OR = 31.4; 95% CI: 23.1-42.8), increased need for FMV (OR = 7.8; 95% CI: 5.9-10.1), BA (OR = 21.7; 95% CI: 12.7-37.0), deaths (OR = 9.9; 95% CI: 5.6-17.5), and FSB (OR = 35; 95% CI: 20.3-60.4). An undetected FHR predicted FSB (OR = 1,983; 95% CI: 922-4,264).


CONCLUSIONS
Intermittent detection of an absent or abnormal FHR using a fetal stethoscope is associated with FSB, increased need for neonatal resuscitation, BA, and neonatal death in a limited-resource setting. The likelihood of an abnormal FHR is magnified with labor complications.
Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway. lehe@sus.no
Hege
H
Langli Ersdal
Estomih
E
Mduma
Erling
E
Svensen
Johanne
J
Sundby
Jeffrey
J
Perlman
D001238:Asphyxia Neonatorum / Q000175:diagnosis / Q000209:etiology*; D003643:Death; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D005323:Fetal Monitoring / Q000379:methods; D006295:Health Resources / Q000600:supply & distribution; D006331:Heart Diseases / Q000150:complications / Q000151:congenital / Q000175:diagnosis* / Q000401:mortality; D006340:Heart Rate, Fetal / Q000502:physiology*; D006771:Hospitals, Maternity / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D019370:Observation; D011203:Poverty / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011446:Prospective Studies; D012151:Resuscitation / Q000706:statistics & numerical data; D012307:Risk Factors; D050497:Stillbirth; D013636:Tanzania / Q000453:epidemiology