RANDOMIZED CONTROLLED TRIAL OF INTRAPARTUM FETAL HEART-RATE MONITORING

Objective--To compare effectiveness of different methods of monitoring intrapartum fetal heart rate. Design-Prospective randomised controlle d trial. Setting-Referral maternity hospital, Harare, Zimbabwe. Subjec ts-1255 women who were 37 weeks or more pregnant with singleton cephal ic presentation and normal fetal heart rate before entry into study. I nterventions-Intermittent monitoring of fetal heart rate by electronic monitoring, Doppler ultrasound, use of Pinard stethoscope by a resear ch midwife, or routine use of Pinard stethoscope by attending midwife. Main outcome measures-Abnormal fetal heart rate patterns, need for op erative delivery for fetal distress, neonatal mortality, Apgar scores, admission to neonatal unit, neonatal seizures, and hypoxic ischaemic encephalopathy. Results-Abnormalities in fetal heart rate were detecte d in 54% (172/318) of the electronic monitoring group, 32% (100/312) o f the ultrasonography group, 15% (47/310) of the Pinard stethoscope gr oup, and 9% (28/315) of the routine monitoring group. Caesarean sectio ns were performed for 28% (89), 24% (76), 10% (32), and 15% (46) of th e four groups respectively. Neonatal outcome was best in the ultrasono graphy group: hypoxic ischaemic encephalopathy occurred in two, one, s even, and 10 cases in the four groups respectively; neonatal seizures occurred only in the last two groups (six and nine cases respectively) ; and deaths occurred in eight, two, five, and nine cases respectively . Conclusions-Abnormalities in fetal heart rate were more reliably det ected by Doppler ultrasonography than with Pinard stethoscope, and its use resulted in good perinatal outcome. The use of relatively cheap u ltrasound monitors should be further evaluated and promoted in obstetr ic units caring for high risk pregnancies in developing countries with scarce resources.