Randomized controlled trial of continuous Doppler versus intermittent fetoscope fetal heart rate monitoring in a low‐resource setting

• Published in: International journal of gynecology and obstetrics Vol. 143; no. 3; pp. 344 - 350
• Main Authors: Mdoe, Paschal F., Ersdal, Hege L., Mduma, Estomih, Moshiro, Robert, Dalen, Ingvild, Perlman, Jeffrey M., Kidanto, Hussein
• Format: Journal Article
• Language: English
• Published: United States 01.12.2018
• Subjects: Adult; Continuous Doppler; Developing Countries; Female; Fetal Distress - diagnosis; Fetal heart rate monitoring; Fetal Monitoring - methods; Fetoscopy; Heart Rate, Fetal; Humans; Infant; Infant, Newborn; Intermittent fetoscope; Labor, Obstetric; Low‐resource settings; Male; Moyo; Perinatal mortality; Pregnancy; Tanzania; Ultrasonography, Doppler; Young Adult; Tanzania; Perinatal mortality; Fetal heart rate monitoring; Moyo; Intermittent fetoscope; Low-resource settings; Continuous Doppler
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.12648

Objective To compare the frequency of abnormal fetal heart rate (FHR) detection between continuous Doppler and intermittent fetoscope monitoring. Method A randomized controlled open‐label trial was conducted between February 1, 2016, and January 31, 2017, at Haydom Lutheran hospital, Tanzania. Women in active labor with singleton pregnancies and normal FHR at admission were randomly allocated in a 1:1 ratio to receive either continuous or intermittent FHR monitoring. The primary outcome was abnormal FHR detection. Results 2652 women were enrolled; 1340 received continuous monitoring and 1312 received intermittent monitoring. Continuous FHR monitoring detected abnormal FHR in 108 (8.1%) participants versus 40 (3.0%) participants in the intermittent monitoring group (risk ratio [RR] 2.64, 95% confidence interval [CI] 1.8–3.7; P<0.001). The increased detection rate in the continuous versus intermittent monitoring group was associated with an increase in rate of subsequent intrauterine resuscitations (89 [6.6%] vs 42 [3.2%]; RR 2.07, 95% CI 1.4–2.9; P<0.001). In total, 92 (3.5%) infants had adverse perinatal outcomes, with no significant differences between groups. Conclusion Continuous FHR monitoring increased identification of abnormal FHR and subsequent intrauterine resuscitations. ClinicalTrials.gov: NCT02790814. A strap‐on continuous Doppler detects fetal heart rate abnormalities almost three times more often than intermittent assessment with fetoscopes in a rural low‐resource setting.