10 Effective fetal heart rate (FHR) monitoring tools for early detection of FHR abnormalities should facilitate appropriate obstetrical interventions, and hence contribute to the reduction of FSB and early deaths. 7, 8 A focus on high coverage of good quality care during birth, including timely identification and rescue of the fetus from intrapartum hypoxia, 9 will save the lives of many newborns. 6 Long-term outcomes include cognitive and behavioral disabilities – affecting perhaps as much as one million children each year. Short-term outcomes include stillbirth, low Apgar score, need for resuscitations, neonatal intensive care unit admissions, and early neonatal deaths. Intrapartum interruption of placental blood flow to the fetus has both short-term and long-term adverse consequences. 2 Annually, 1.02 million fresh stillbirths (FSB) occur, 1, 3, 4 and intrapartum-related neonatal deaths account for almost 40% of 2.6 million neonatal deaths. 1 More than 99% of all newborn deaths occur in LIC, with important causes including lack of skilled personnel, essential technology, and supplies, including medicines. Keywords: fetal heart rate, perinatal outcomes, Pinard stethoscope, DopplerĬhildbirth is regarded as a normal physiological process however, in low-income countries (LIC) there is an increased risk of mortality for both the mother and her newborn. Perinatal outcomes were better among vaginally delivered newborns with detected abnormal FHR in the Doppler arm. Time intervals from abnormal FHR detection to delivery were longer than recommended in both arms. The incidence of adverse perinatal outcomes (fresh stillbirths, 24-hour neonatal admissions, and deaths) was similar overall however, among newborns with abnormal FHR delivered vaginally, adverse outcomes were less incident in Doppler (7 of 43 births, 16.3%) than in the Pinard arm (10 of 23 births, 43.5%), p=0.021.Ĭonclusion: Intermittent FHR monitoring using Doppler was associated with an increased detection of abnormal FHR compared to Pinard in a low-risk population. Median (interquartile range) time from abnormal FHR detection to delivery was comparable between Doppler and Pinard, ie, 80 (60,161) and 89 (52,165) minutes, respectively, as was the incidence of cesarean delivery (12.0% versus 12.2%). Abnormal FHRs were more often detected in the Doppler (6.0%) versus the Pinard (3.9%) arm (adjusted odds ratio =1.59, 95% confidence interval: 1.13–2.26, p=0.008). Results: In total, 2,844 eligible women were assigned to FHR monitoring with Pinard (n=1,423) or Doppler (n=1,421). Unadjusted and adjusted odds ratios were calculated with respective 95% confidence interval. χ 2, Fisher’s exact test, Mann–Whitney test, and logistic regression were conducted. Secondary endpoints were time to delivery, mode of delivery, and perinatal outcomes. Women with gestational age ≥37 weeks, cephalic presentation, normal FHR on admission, and cervical dilatation 160 beats/min). Materials and methods: We conducted a randomized controlled study at Muhimbili National Hospital, Tanzania, from April 2013 to September 2015. The objective was to compare the Pinard stethoscope versus a new wind-up handheld Doppler in the detection of abnormal FHR. Handheld Dopplers are rarely available and are dependent on batteries or electricity. Benjamin A Kamala, 1,2 Hussen L Kidanto, 3,4 Peter J Wangwe, 2,5 Ingvild Dalen, 3 Estomih R Mduma, 3,6 Jeffrey M Perlman, 7 Hege L Ersdal 1,8ġFaculty of Health Sciences, University of Stavanger, Stavanger, Norway 2Department of Obstetrics and Gynecology, Muhimbili National Hospital, Dar es Salaam, Tanzania 3Department of Research, Stavanger University Hospital, Stavanger, Norway 4School of Medicine, Aga Khan University, Dar es Salaam, Tanzania 5Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania 6Department of Research, Haydon Lutheran Hospital, Manyara, Tanzania 7Department of Pediatrics, Weill Medical College, New York, NY, USA 8Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norwayīackground: Fetal stethoscopes are mainly used for intermittent monitoring of fetal heart rate (FHR) during labor in low-income countries, where perinatal mortality is still high.
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