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Stethoscope Remains Best Way to Monitor Fetal Distress During Labor

WEDNESDAY, April 7, 2021 -- Listening to a fetal heart rate using a stethoscope is still the best method for determining whether a baby is in distress during delivery, according to a review published online April 6 in CMAJ, the journal of the Canadian Medical Association.

Bassel H. Al Wattar, Ph.D., from the University of Warwick in the United Kingdom, and colleagues conducted a systematic literature review to identify randomized trials evaluating any intrapartum fetal surveillance method.

Based on 33 identified studies (118,863 patients), the researchers found that intermittent auscultation (IA) reduced the risk for emergency cesarean deliveries versus other types of surveillance (risk ratios, 0.83, 0.71, 0.77, 0.75, and 0.81, for IA versus cardiotocography [CTG], CTG with fetal scalp pH analysis [FBS], CTG with fetal scalp lactate, CTG with fetal pulse oximetry [FPO], and CTG with FBS and FPO, respectively; risk ratio for computerized cardiotocography with FBS versus IA, 1.21). Results were similar for reduction in cesarean deliveries for fetal distress. However, there was no reduction in risk noted for neonatal acidemia, neonatal unit admissions, Apgar scores, or perinatal death for any of the evaluated methods.

"Our analysis suggests that all additional methods introduced to improve the accuracy of electronic fetal heart monitoring have failed to reduce the risk of adverse neonatal or maternal outcomes beyond what IA achieved 50 years ago, and this may have contributed to the increased incidence of unnecessary emergency cesarean deliveries," the authors write.

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