Intrapartum fetal heart rate monitoring in a combined low- and high-risk population: a controlled clinical trial

doi:10.1016/0028-2243(86)90099-7

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 23, Issues 1–2, October 1986, Pages 1-11

https://doi.org/10.1016/0028-2243(86)90099-7 Get rights and content

Abstract

In a prospective clinical randomized investigation 487 women had the condition of the fetus during labour supervised by means of stethoscope (AUS), while 482 women went through labour under surveillance of electronic fetal monitoring, cardiotocography (EFM). 349 women refused to participate in the investigation (NAI) and had delivery conducted according to the normal procedures of the department (70% AUS, 30% EFM).

Significantly more pathological fetal heart rate patterns (FHR) were found in the EFM group compared to the AUS group in both the first and the second stage of labour. As a result significantly more vacuum extractions were performed in the EFM group than in the AUS group, while no statistical difference was found between the groups in the incidence of acute cesarean sections carried out for asphyxia.

One case of intrapartum death occurred in the AUS group.

No differences were found in Apgar scores after 1 and 5 min or in neonatal morbidity at examination on the 2nd and 5th days after delivery. A tendency towards more biochemically compromised children was found in the AUS group.

The specificity for both methods was found to be acceptably high (80%), while the predictive value for both methods was low (50%). More research is therefore urgently needed to evaluate supplementary investigations and parameters for the evaluation of the intrapartum fetal condition.

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Citation Excerpt :
Of note, 7 studies reported the incidence of cesarean delivery13,14,17,19,20,23,25 with no difference seen between the 2 groups (OR, 0.84; 95% CI, 0.69–1.02). Of the 2 studies that focused on intrapartum interventions,23,25 there remained no difference in the incidence of cesarean delivery (OR, 0.96; 95% CI, 0.43–2.13). This systematic review and meta-analysis of 17 international studies in the last 4 decades compared outcomes between participants and nonparticipants in obstetrical randomized trials.
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After reviewing more than 1100 abstracts, 17 obstetrical randomized controlled trials (103,610, with 26,293 participants and 77,317 nonparticipants) met our inclusion criteria and were analyzed. Of note, 9 studies were not rated as high quality, primarily for failing to control for confounding factors. Trial interventions were categorized as antepartum (n=11), intrapartum (n=5), or postpartum (n=1). Overall, participants in obstetrical randomized controlled trials had no difference in outcomes compared with nonparticipants (n=17: odds ratio, 0.88; 95% confidence interval, 0.52–1.49; I²=90%). Moreover, there was no difference seen when only randomized controlled trials that reported a primary outcome were included (n=12: odds ratio, 0.76; 95% confidence interval, 0.38–0.1.49; I²=93%). In addition, there was no difference noted in the subgroup where the randomized controlled trial intervention was not available to nonparticipants (n=7: odds ratio, 0.91; 95% confidence interval, 0.45–1.85; I²=68%).
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Intrapartum fetal heart rate monitoring in a combined low- and high-risk population: a controlled clinical trial

Abstract

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

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Eur J Obstet Gynecol Reprod Biol