Abstract
ObjectiveTo determine acceptable and achievable strategies of intrapartum fetal monitoring in busy low‐resource settings.MethodsThree rounds of online Delphi surveys were conducted between January 1 and October 31, 2017. International experts with experience in low‐resource settings scored the importance of intrapartum fetal monitoring methods.Results71 experts completed all three rounds (28 midwives, 43 obstetricians). Consensus was reached on (1) need for an admission test, (2) handheld Doppler for intrapartum fetal monitoring, (3) intermittent auscultation (IA) every 30 minutes for low‐risk pregnancies during the first stage of labor and after every contraction for high‐risk pregnancies in the second stage, (4) contraction monitoring hourly for low‐risk pregnancies in the first stage, and (5) adjunctive tests. Consensus was not reached on frequency of IA or contraction monitoring for high‐risk women in the first stage or low‐risk women in the second stage of labor.ConclusionThere is a gap between international recommendations and what is physically possible in many labor wards in low‐resource settings. Research on how to effectively implement the consensus on fetal assessment at admission and use of handheld Doppler during labor and delivery is crucial to support staff in achieving the best possible care in low‐resource settings.
Highlights
Almost all perinatal deaths occur in low-and middle-income countries (LMICs), and half occur intrapartum.[1]
With use of a Delphi procedure, we aimed to determine a package of achievable strategies of intrapartum fetal monitoring for busy low-resource maternity wards with a focus on admission tests, fetal heart rate (FHR) monitoring, adjunctive tests, and contraction monitoring in relation to low-and high-risk pregnancies in the first and second stage of labor
The international Delphi procedure with input from experts from 39 countries resulted in consensus on five aspects of intrapartum fetal monitoring for busy low-resource maternity units: (1) need for an admission test, (2) handheld Doppler as the recommended method of intrapartum FHR monitoring, (3) frequency of intermittent auscultation (IA) for low-risk pregnancies during the first stage of labor and frequency of IA for high-risk women in the second stage, (4) frequency of contraction monitoring for low-risk pregnancies in the first stage of labor, (5) adjunctive tests to FHR monitoring
Summary
Almost all perinatal deaths occur in low-and middle-income countries (LMICs), and half occur intrapartum.[1]. Practice is guided by expert consensus and obstetric culture, which often originate in high- income countries.[8] For low-risk pregnancies, assessment of fetal heart rate (FHR) by intermittent auscultation (IA) for 30–60 seconds is commonly recommended every 15 or 30 minutes in the active phase of the first stage of labor, and after every contraction or at 5-m inute intervals in the second stage. Identification of techniques of intrapartum fetal monitoring Systematic review International/national/local guidelines. With use of a Delphi procedure, we aimed to determine a package of achievable strategies of intrapartum fetal monitoring for busy low-resource maternity wards with a focus on admission tests, FHR monitoring, adjunctive tests, and contraction monitoring in relation to low-and high-risk pregnancies in the first and second stage of labor
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