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Intermittent auscultation may reduce the risk of emergency caesarean section




April 6, 2021

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Patients monitored with intermittent auscultation and other fetal surveillance types had a lower risk of emergency caesarean section and a lower risk of neonatal or maternal adverse outcomes, a meta-analysis found.

Bassell H. Al Water,doctorate, Doctors at Warwick Medical College in the United Kingdom told Healtho Primary Care that electrocardiography “continues to provide more information about fetal heart rate” and “continues to be the most widely used and recommended during labor around the world.” It’s a fetal monitoring tool, but “its real value remains,” he said. It is controversial. “

"Regardless of some development ... none of these tools seem to have any advantages over using intermittent auscultation." -Dr. Bassell H. Alwatter

Al Wattar et al. Evaluated the effectiveness of various types of fetal surveillance. This includes intermittent auscultation with a Pinard stethoscope / handheld Doppler. Computerized cardiac tocography; electrocardiography with fetal scalp lactic acid, pH analysis of the fetal scalp, fetal pulse oximetry, and electrocardiogram of the fetal heart. Similar to their combination — a meta-analysis of 33 trials containing data on 118,863 patients.The main outcome indicators for this study are Incidence of emergency caesarean section..

Data include reduced risk of cesarean delivery with intermittent auscultation and electrocardiography (RR = 0.83; 95% CI, 0.72-0.97), electrocardiography with fetal scalp pH analysis (RR = 0.71; 95% CI, 0.63–0.80) ), Showed an electrocardiogram. Fetal scalp lactate (RR = 0.77; 95% CI, 0.64–0.92), cardiac tocography with fetal pulse oximetry (RR = 0.75; 95% CI, 0.65–0.87), and fetal pulse oximetry and fetal blood pH Cardiac tocography with sampling (RR = 0.81; 95% CI, 0.67–0.99).

The researchers also found that the risk ratio for computer-assisted cardiac tocography using blood pH sampling of the fetal scalp was 1.21 (95% CI, 1.04-1.42). However, they write that the risk of caesarean section was not reduced between intermittent auscultation and fetal electrocardiography and fetal scalp blood pH sampling.

None of the methods evaluated were associated with reduced risk of neonatal acidosis, neonatal unit admission, Apgar score or perinatal mortality, according to the researchers.

“Importantly, despite the development of several tools used to monitor calving babies over the last 30 years, none of these tools have advantages over using intermittent auscultation. It doesn’t seem to be, “says Al Wattar.

He also shows that the findings “need to invest more in clinical research to develop new monitoring tools that may help reduce labor risk while reducing the need for emergencies. “. Caesarean section“It’s especially related to high-risk pregnancies that need research to identify useful monitoring tools that enable safe delivery of mothers and their babies,” he adds.

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