@article{b0a0220db9ab40adb00897195a6cc926,
title = "Randomized controlled trial of continuous Doppler versus intermittent fetoscope fetal heart rate monitoring in a low-resource setting",
abstract = "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.",
keywords = "Continuous Doppler, Fetal heart rate monitoring, Intermittent fetoscope, Low-resource settings, Moyo, Perinatal mortality",
author = "Mdoe, {Paschal F.} and Ersdal, {Hege L.} and Estomih Mduma and Robert Moshiro and Ingvild Dalen and Perlman, {Jeffrey M.} and Hussein Kidanto",
note = "Funding Information: Funding Information Laerdal Foundation; Saving Lives at Birth; Research Council of Norway. We acknowledge the contribution of all Haydom Lutheran Hospital staff and participating women. This work was supported by the Laerdal Foundation, Saving lives at Birth, and partly by the Research Council of Norway (project number 228203). Funding Information: is a desired goal.13,14 A prolonged D鸀me interval between the last FHR PFM, HLE, EM, and HK contributed to study design, data collecD鸀on, assessment and cesarean secD鸀on may have also contributed to poor data analysis, and manuscript wriD鸀ng. RM, ID, and JMP contributed to fetal outcome, a finding consistent with other reports.15,16 Clearly, data analysis and manuscript wriD鸀ng. All authors criD鸀cally reviewed it is difficult to demonstrate improvements in neonatal outcome, and approved the final manuscript. even with early detecD鸀on of an abnormal FHR, if there is a delay in obstetric responses. ACKNOWLE?GMENTS The increased rates of cesarean secD鸀on in the conD鸀nuous versus the intermittent monitoring group were secondary to an abnormal We acknowledge the contribuD鸀on of all Haydom Lutheran Hospital FHR. In a Cochrane review, Alfirevic et al. presented similar find-staff and parD鸀cipaD鸀ng women. This work was supported by the ings showing that conD鸀nuous FHR monitoring was associated with Laerdal FoundaD鸀on, Saving lives at Birth, and partly by the Research increased cesarean secD鸀on rates versus intermittent monitoring, with Council of Norway (project number 228203). no difference in immediate neonatal outcomes.17 Most complicated labors (95%) were delivered via cesarean secD鸀on, which in turn were associated with more adverse perinatal outcomes, including fresh sD鸄ql- birth, findings that are consistent with those of Kidanto et al.18 Publisher Copyright: {\textcopyright} 2018 International Federation of Gynecology and Obstetrics",
year = "2018",
month = dec,
doi = "10.1002/ijgo.12648",
language = "English",
volume = "143",
pages = "344--350",
journal = "International Journal of Gynecology and Obstetrics",
issn = "0020-7292",
publisher = "John Wiley and Sons Ltd",
number = "3",
}