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BMJ Open. 2015 Jan 30;5(1):e006867. doi: 10.1136/bmjopen-2014-006867.

Use of wind-up fetal Doppler versus Pinard for fetal heart rate intermittent monitoring in labour: a randomised clinical trial.

Author information

1
Department of Obstetrics and Gynaecology, St. Raphael of St. Francis Hospital Nsambya, Kampala, Uganda.
2
Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada.
3
Powerfree Education and Technology, Cape Town, South Africa.
4
Department of Obstetrics and Gynaecology, Uganda Martyrs Hospital Rubaga, Kampala, Uganda.
5
London School of Hygiene & Tropical Medicine, London, UK.

Abstract

OBJECTIVES:

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.

DESIGN:

Prospective equally randomised clinical trial.

SETTING:

The labour and delivery unit of a teaching hospital in Kampala, Uganda.

PARTICIPANTS:

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.

INTERVENTION:

Intermittent FHR monitoring using Doppler.

PRIMARY OUTCOME MEASURES:

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.

TRIAL REGISTRATION NUMBER:

Clinical Trails.gov (1000031587).

KEYWORDS:

NEONATOLOGY; PRIMARY CARE

PMID:
25636792
PMCID:
PMC4316429
DOI:
10.1136/bmjopen-2014-006867
[Indexed for MEDLINE]
Free PMC Article

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