INTRAPARTUM FETAL HEART-RATE MONITORING - CONTINUOUS ELECTRONIC VERSUS INTERMITTENT DOPPLER - A RANDOMIZED CONTROLLED TRIAL

Objective - to compare different methods of intrapartum foetal heart r ate monitoring in high risk pregnancies in detecting foetal heart rate abnormalities, need for operative delivery for foetal distress, and n eonatal mortality and short term neonatal morbidity. Design - a prospe ctive randomised controlled trial. Setting- women in labour at a refer ral maternity hospital. Patients - women who were 37 weeks or more pre gnant with singleton cephalic presentation and normal foetal heart rat e prior to entry into the study. Intervention - women were randomly al located using sealed opaque envelopes to either continuous electronic foetal heart rate monitoring or intermittent monitoring using hand hel d doppler foetal heart rate detector. Outcome measures - these include abnormal foetal heart rate patterns, need for operative delivery for foetal distress, neonatal mortality, Apgar scores, admission to NNU, n eonatal seizures, and hypoxic encephalopathy. Results -randomisation a chieved good comparability between the two groups. Abnormal FHR patter ns were more frequent in the electronic group (54 pc versus 32 pc). Ca esarean section rate was not significantly different in the two groups (28 pc versus 24 pc) although slightly higher compared to overall for the unit (18pc). Foetal outcome was also comparable between the two g roups. Conclusions - asphyxia can be detected with a hand held doppler just as reliably as by the use of electronic monitors and their use s hould be further evaluated and promoted in obstetric units caring for high risk pregnancies in developing countries with scarce resources.