Abstract
BackgroundUsing Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalities coupled with appropriate, timely intrapartum care in low‐ and middle‐income countries (LMIC) can save lives.ObjectiveTo review studies using Doppler to improve detection of intrapartum FHR abnormalities and intrapartum care quality in LMIC health facilities.Search strategyPubMed, Web of Science, Embase, Global Health, and Scopus were searched from inception to October 2018 by combining terms for Doppler, perinatal outcomes, and FHR monitoring.Selection criteriaSelected studies compared Doppler and Pinard stethoscope for detecting/monitoring intrapartum FHR, or described provider and maternal preferences for FHR monitoring in LMIC settings.Data collection and analysisTwo team members independently screened and collected data. Risk of bias was assessed by Cochrane EPOC criteria.ResultsEleven studies from eight countries were included. Doppler was superior at detecting abnormal intrapartum FHR as compared with Pinard stethoscope, but was not associated with improved perinatal outcomes. Using Doppler on admission helped to accurately measure perinatal deaths occurring after facility admission.ConclusionStudies and program learning are needed to translate improved detection of FHR abnormalities to improved case management in LMICs. Doppler should be used to calculate a facility indicator of intrapartum care quality. PROSPERO registration: CRD42019121924.
Highlights
Adverse perinatal outcomes were defined as intrapartum stillbirth, neonatal death within 24 hours, neonatal seizures, hypoxic ischemic encephalopathy, bag and mask ventilation, or admission to the neonatal intensive care unit (NICU)
Two studies documented a reduction in perinatal adverse events associated with intermittent Doppler monitoring of intrapartum fetal heart rate (FHR) as compared with intermittent monitoring with the Pinard fetoscope.[15,18]
In the other four studies, no difference in adverse perinatal outcomes was seen between Doppler and Pinard fetoscope for FHR monitoring (Table 1).[15,16,17,19]
Summary
Most intrapartum stillbirths and neonatal deaths that occur in health facilities can be prevented by good obstetric care,[3] essential newborn care, and prompt identification and resuscitation of asphyxiated neonates.[4]. Interruption of placental blood flow during labor can result in fetal heart rate (FHR) acceleration, deceleration, bradycardia (160 bpm) Such FHR abnormalities have been associated with low Apgar score, intrapartum stillbirth, and neonatal death.[5,6] Early detection of FHR abnormalities, linked to timely and appropriate obstetric case management practices, can potentially reduce adverse perinatal outcomes.
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