ROUTINE OR COMPUTERIZED CARDIOTOCOGRAPHY IN SEVERE PREECLAMPSIA - A RANDOMIZED CONTROLLED TRIAL

Objective: To determine whether the reported saving in time required f or fetal heart rate monitoring when using a computerized system of sur veillance could also be achieved in patients with severe early onset p reeclampsia who were managed expectantly. Methods: Patients with sever e preeclampsia before 34 weeks gestation who qualified for expectant m anagement were randomly allocated to either conventional or computeriz ed fetal heart rate monitoring Both groups were monitored four times d aily. In the former group, monitoring was discontinued after 10 min, p rovided that the fetal heart rate variability was more than 5 beats/mi n. Recordings in the computerized group were done with the Sonicaid Sy stem 8000 and continued until the Dawes and Redman criteria were met. Results: The median time per recording was 20 min in the computerized group and 10 min In the conventionally monitored group (P < 0.0001). T he Dawes and Redman criteria had not been met after 60 min in 14% of r ecordings in the computerized group. More deliveries were done primari ly for fetal distress in the Sonicaid System 8000 group (16 versus 9, P = 0.14), but this was reversed in labor, where six patients in the c onventionally monitored group developed fetal distress as compared wit h one iu the computerized group. Conclusions: Fetal heart rate monitor ing in patients with severe preeclampsia remote from term took signifi cantly longer to perform when using the Sonicaid System 8000. However, subtle changes of fetal distress may have been missed Frier to labor in the conventionally monitored group.