Neonatal Outcomes of Continues Fetal Heart Rate Monitoring in Low-Risk Pregnant Women During Labor
-
Sedigheh Ayati
,
leila Pourali
,
Masoumeh Mirteimouri
,
Atiyeh Vatanchi
,
Maryam Salehi
,
Elaheh Hasanzadeh
Abstract
Various methods are used in order to describe the heart rate patterns of the fetus. The use of electronic monitoring during labor is widely accepted today. The aim of this study was to compare the neonatal outcomes of continuous Fetal Heart Rate (FHR) monitoring to intermittent auscultation among low-risk pregnant women during labor. This randomized clinical trial was conducted among 900 low-risk pregnant women who met inclusion criteria and were admitted to maternity wards of academic hospitals of Mashhad University of Medical Sciences for labor. They were randomly divided into two groups: the intermittent auscultation group and the Continuous FHR monitoring group. The pregnancy and neonatal outcomes were compared in two groups; data were processed in SPSS16 software. P less than 0.05 was considered as significant level. In this study, the first and fifth minutes Apgar scores, the rate of NICU admission, advance resuscitation requirement, neonatal seizure incidence, and the neonatal or fetal death did not differ significantly between two groups (P>0.05). In the Continues monitoring group, the rate of cesarean section due to fetal distress and operative vaginal delivery was significantly higher rather than the other group (P=0.001). The results of this study showed that continuous FHR monitoring in low-risk pregnancies during labor increases the risk of cesarean and instrumental delivery without improving neonatal outcomes.
1. Y VY Global, regional and national perinatal and neonatal mortality. J perinatal med 2003;31:376-9.
2. Allanson ER, Muller M, Pattinson RC. Causes of perinatal mortality and associated maternal complications in a South African province: challenges in predicting poor outcomes. BMC pregnancy childbirth. 2015;15:37.
3. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet 2005;365:891-900.
4. Cunningham FG, Leveno KJ, Bloom SL. Intrapartum Assessment. In: Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al., eds. Williams Obstetrics. 25th ed. United States: NY: McGraw-Hill Education,2018:457-84.
5. Ananth CV, Chauhan SP, Chen HY, D'Alton ME, Vintzileos AM. Electronic fetal monitoring in the United States: temporal trends and adverse perinatal outcomes. ObstetGynecol 2013;121:927-33.
6. Alfirevic Z, Stampalija T, Gyte GM. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Sys Rev 2013:11;Cd007529.
7. Ayres-de-Campos D, Spong CY, Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J GynaecolObstet 2015;131:13-24.
8. Alfirevic Z, Devane D, Gyte GM, Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2017;2:Cd006066.
9. Ashwal E, Shinar S, Aviram A, Orbach S, Yogev Y, Hiersch L. A novel modality for intrapartum fetal heart rate monitoring. J Matern Fetal Neonatal Med 2017;2:1-7.
10. Philopoulos D. [Electronic fetal monitoring and its relationship to neonatal and infant mortality in a national database: A sensitivity analysis]. J GynecolObstetBiolReprod (Paris) 2015;44(5):451-62.
11. Chen HY, Chauhan SP, Ananth CV, Vintzileos AM, Abuhamad AZ. Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States. Am J ObstetGynecol 2011;204:491.e1-10.
12. Vintzileos AM, Nochimson DJ, Guzman ER, Knuppel RA, Lake M, Schifrin BS. Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: a meta-analysis. ObstetGynecol 1995;85:149-55.
13. MacLennan AH, Thompson SC, Gecz J. Cerebral palsy: causes, pathways, and the role of genetic variants. Am J ObstetGynecol 2015;213:779-88.
14. Heelan L. Fetal monitoring: creating a culture of safety with informed choice. J Perinat Educ 2013;22:156-65.
15. Grimes DA, Peipert JF. Electronic fetal monitoring as a public health screening program: the arithmetic of failure. ObstetGynecol 2010;116:1397-400.
16. Schulten PS, Suppelna JP, Dagres T, Noe G, Anapolski M, Reinhard J, et al. [Comparison of International Guidelines For the Application of Cardiotocography]. Z GeburtshilfeNeonatol 2018;222:66-71.
17. Graham EM, Petersen SM, Christo DK, Fox HE. Intrapartum electronic fetal heart rate monitoring and the prevention of perinatal brain injury. Obstetgynecol 2006;108:656-66.
18. Liston R, Crane J, Hamilton E, Hughes O, Kuling S, MacKinnon C, et al. Fetal health surveillance in labour. J obstetgynaecol Can2002;24:250-76.
19. ACOG. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstetgynecol 2009;114:192-202.
20. Herbst A, Ingemarsson I. Intermittent versus continuous electronic monitoring in labour: a randomised study. Br J
ObstetGynaecol 1994;101:663-8.
21. Smith V, Begley CM, Clarke M, Devane D. Professionals' views of fetal monitoring during labour: a systematic review and thematic analysis. BMC pregnancy childbirth 2012;12:166.
22. VelimalaRatna K, Indiramani I, Chakravarthy K, Anitha A. A comparative study of perinatal Outcome in low risk pregnancies with CTG monitoring and intermittent Ascultation. J Evol Med Dent Sci 2015;4:17038-42.
23. Kelso IM, Parsons RJ, Lawrence GF, Arora SS, Edmonds DK, Cooke ID. An assessment of continuous fetal heart rate monitoring in labor. A randomized trial. Am J ObstetGynecol 1978;131:526-32.
24. Thacker SB, Stroup D, Chang M. Continuous electronic heart rate monitoring for fetal assessment during labor. The Cochrane Database Syst Rev 2001;2:Cd000063.
25. Sartwelle TP, Johnston JC. Cerebral palsy litigation: change course or abandon ship. J Child Neurol 2015;30:828-41.
26. Nelson KB, Sartwelle TP, Rouse DJ. Electronic fetal monitoring, cerebral palsy, and caesarean section: assumptions versus evidence. BMJ 2016;355:i6405.
27. Clark SL, Hamilton EF, Garite TJ, Timmins A, Warrick PA, Smith S. The limits of electronic fetal heart rate monitoring in the prevention of neonatal metabolic acidemia. Am J ObstetGynecol 2017;216:163.e1-.e6.
28. Soncini E, Paganelli S, Vezzani C, Gargano G, Giovanni Battista LS. Intrapartum fetal heart rate monitoring: evaluation of a standardized system of interpretation for prediction of metabolic acidosis at delivery and neonatal neurological morbidity. J Matern Fetal Neonatal Med 2014;27:1465-9.
29. Group IC. Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial. Lancet 2017;389:1719-29.
30. Nunes I, Ayres-de-Campos D, Ugwumadu A, Amin P, Banfield P, Nicoll A, et al. Central Fetal Monitoring With and Without Computer Analysis: A Randomized Controlled Trial. Obstetgynecol 2017;129:83-90.
2. Allanson ER, Muller M, Pattinson RC. Causes of perinatal mortality and associated maternal complications in a South African province: challenges in predicting poor outcomes. BMC pregnancy childbirth. 2015;15:37.
3. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet 2005;365:891-900.
4. Cunningham FG, Leveno KJ, Bloom SL. Intrapartum Assessment. In: Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al., eds. Williams Obstetrics. 25th ed. United States: NY: McGraw-Hill Education,2018:457-84.
5. Ananth CV, Chauhan SP, Chen HY, D'Alton ME, Vintzileos AM. Electronic fetal monitoring in the United States: temporal trends and adverse perinatal outcomes. ObstetGynecol 2013;121:927-33.
6. Alfirevic Z, Stampalija T, Gyte GM. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Sys Rev 2013:11;Cd007529.
7. Ayres-de-Campos D, Spong CY, Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J GynaecolObstet 2015;131:13-24.
8. Alfirevic Z, Devane D, Gyte GM, Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2017;2:Cd006066.
9. Ashwal E, Shinar S, Aviram A, Orbach S, Yogev Y, Hiersch L. A novel modality for intrapartum fetal heart rate monitoring. J Matern Fetal Neonatal Med 2017;2:1-7.
10. Philopoulos D. [Electronic fetal monitoring and its relationship to neonatal and infant mortality in a national database: A sensitivity analysis]. J GynecolObstetBiolReprod (Paris) 2015;44(5):451-62.
11. Chen HY, Chauhan SP, Ananth CV, Vintzileos AM, Abuhamad AZ. Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States. Am J ObstetGynecol 2011;204:491.e1-10.
12. Vintzileos AM, Nochimson DJ, Guzman ER, Knuppel RA, Lake M, Schifrin BS. Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: a meta-analysis. ObstetGynecol 1995;85:149-55.
13. MacLennan AH, Thompson SC, Gecz J. Cerebral palsy: causes, pathways, and the role of genetic variants. Am J ObstetGynecol 2015;213:779-88.
14. Heelan L. Fetal monitoring: creating a culture of safety with informed choice. J Perinat Educ 2013;22:156-65.
15. Grimes DA, Peipert JF. Electronic fetal monitoring as a public health screening program: the arithmetic of failure. ObstetGynecol 2010;116:1397-400.
16. Schulten PS, Suppelna JP, Dagres T, Noe G, Anapolski M, Reinhard J, et al. [Comparison of International Guidelines For the Application of Cardiotocography]. Z GeburtshilfeNeonatol 2018;222:66-71.
17. Graham EM, Petersen SM, Christo DK, Fox HE. Intrapartum electronic fetal heart rate monitoring and the prevention of perinatal brain injury. Obstetgynecol 2006;108:656-66.
18. Liston R, Crane J, Hamilton E, Hughes O, Kuling S, MacKinnon C, et al. Fetal health surveillance in labour. J obstetgynaecol Can2002;24:250-76.
19. ACOG. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstetgynecol 2009;114:192-202.
20. Herbst A, Ingemarsson I. Intermittent versus continuous electronic monitoring in labour: a randomised study. Br J
ObstetGynaecol 1994;101:663-8.
21. Smith V, Begley CM, Clarke M, Devane D. Professionals' views of fetal monitoring during labour: a systematic review and thematic analysis. BMC pregnancy childbirth 2012;12:166.
22. VelimalaRatna K, Indiramani I, Chakravarthy K, Anitha A. A comparative study of perinatal Outcome in low risk pregnancies with CTG monitoring and intermittent Ascultation. J Evol Med Dent Sci 2015;4:17038-42.
23. Kelso IM, Parsons RJ, Lawrence GF, Arora SS, Edmonds DK, Cooke ID. An assessment of continuous fetal heart rate monitoring in labor. A randomized trial. Am J ObstetGynecol 1978;131:526-32.
24. Thacker SB, Stroup D, Chang M. Continuous electronic heart rate monitoring for fetal assessment during labor. The Cochrane Database Syst Rev 2001;2:Cd000063.
25. Sartwelle TP, Johnston JC. Cerebral palsy litigation: change course or abandon ship. J Child Neurol 2015;30:828-41.
26. Nelson KB, Sartwelle TP, Rouse DJ. Electronic fetal monitoring, cerebral palsy, and caesarean section: assumptions versus evidence. BMJ 2016;355:i6405.
27. Clark SL, Hamilton EF, Garite TJ, Timmins A, Warrick PA, Smith S. The limits of electronic fetal heart rate monitoring in the prevention of neonatal metabolic acidemia. Am J ObstetGynecol 2017;216:163.e1-.e6.
28. Soncini E, Paganelli S, Vezzani C, Gargano G, Giovanni Battista LS. Intrapartum fetal heart rate monitoring: evaluation of a standardized system of interpretation for prediction of metabolic acidosis at delivery and neonatal neurological morbidity. J Matern Fetal Neonatal Med 2014;27:1465-9.
29. Group IC. Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial. Lancet 2017;389:1719-29.
30. Nunes I, Ayres-de-Campos D, Ugwumadu A, Amin P, Banfield P, Nicoll A, et al. Central Fetal Monitoring With and Without Computer Analysis: A Randomized Controlled Trial. Obstetgynecol 2017;129:83-90.
| Files | ||
| Issue | Vol 58, No 4 (2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v58i4.3919 | |
| Keywords | ||
| Pregnancy outcome Auscultation Fetal heart rate Fetal monitoring | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ayati S, Pourali leila, Mirteimouri M, Vatanchi A, Salehi M, Hasanzadeh E. Neonatal Outcomes of Continues Fetal Heart Rate Monitoring in Low-Risk Pregnant Women During Labor. Acta Med Iran. 2020;58(4):155-160.
