title: Use of wind-up fetal Doppler versus Pinard for fetal heart rate intermittent monitoring in labour: a randomised clinical trial.
abstract: OBJECTIVE
  In resource-poor settings, the standard of care to inform labour management is the partograph plus Pinard stethoscope for intermittent fetal heart rate (FHR) monitoring. We compared FHR monitoring in labour using a novel, robust wind-up handheld Doppler with the Pinard as a primary screening tool for abnormal FHR on perinatal outcomes.
  
  
  METHODS
  Prospective equally randomised clinical trial.
  
  
  METHODS
  The labour and delivery unit of a teaching hospital in Kampala, Uganda.
  
  
  METHODS
  Of the 2042 eligible antenatal women, 1971 women in active term labour, following uncomplicated pregnancies, were randomised to either the standard of care or not.
  
  
  METHODS
  Intermittent FHR monitoring using Doppler.
  
  
  METHODS
  Incidence of FHR abnormality detection, intrapartum stillbirth and neonatal mortality prior to discharge.
  
  
  RESULTS
  Age, parity, gestational age, mode of delivery and newborn weight were similar between study groups. In the Doppler group, there was a significantly higher rate of FHR abnormalities detected (incidence rate ratio (IRR)=1.61, 95% CI 1.13 to 2.30). However, in this group, there were also higher though not statistically significant rates of intrapartum stillbirths (IRR=3.94, 0.44 to 35.24) and neonatal deaths (IRR=1.38, 0.44 to 4.34).
  
  
  CONCLUSIONS
  Routine monitoring with a handheld Doppler increased the identification of FHR abnormalities in labour; however, our trial did not find evidence that this leads to a decrease in the incidence of intrapartum stillbirth or neonatal death.
  
  
  BACKGROUND
  Clinical Trails.gov (1000031587).
authors: Department of Obstetrics and Gynaecology, St. Raphael of St. Francis Hospital Nsambya, Kampala, Uganda.
authors: R
authors: R
authors: Byaruhanga
authors: Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada.
authors: D G
authors: DG
authors: Bassani
authors: Powerfree Education and Technology, Cape Town, South Africa.
authors: A
authors: A
authors: Jagau
authors: Department of Obstetrics and Gynaecology, Uganda Martyrs Hospital Rubaga, Kampala, Uganda.
authors: P
authors: P
authors: Muwanguzi
authors: Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada.
authors: A L
authors: AL
authors: Montgomery
authors: London School of Hygiene & Tropical Medicine, London, UK.
authors: J E
authors: JE
authors: Lawn
mesh_terms: D000328:Adult; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000401:mortality / Q000503:physiopathology*; D005323:Fetal Monitoring / Q000379:methods*; D005333:Fetus / Q000502:physiology*; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology; D006340:Heart Rate, Fetal; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007743:Labor, Obstetric; D066087:Perinatal Death / Q000517:prevention & control*; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D050497:Stillbirth / Q000453:epidemiology; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: NEONATOLOGY; PRIMARY CARE
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