Fetal scalp stimulation test: An adjunct to intermittent auscultation in non‐reassuring fetal status during labor

Rathore, Asmita; Ramji, Siddarth; Devi, Chabungbam Bijayalakshmi; Saini, Sushila; Manaktala, Usha; Batra, Swaraj

doi:10.1111/j.1447-0756.2010.01442.x

Cited by 10 publications

(31 citation statements)

References 8 publications

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“…Many studies were from urban settings (urban: n = 16, rural: n = 1, both: 2), for 18 studies this could not be determined. Studies were on: admission tests and early intrapartum (CTG, n = 7, IA: 1, other methods, n = 6) [ 32 – 35 , 44 , 48 , 51 , 56 , 57 , 59 , 61 ], ongoing intrapartum FHR monitoring (IA, n = 8; CTG, n = 11) [ 26 – 28 , 30 , 31 , 36 – 39 , 41 , 43 , 45 – 47 , 50 , 53 , 58 ], adjunctive tests (n = 9) [ 39 , 41 – 43 , 45 , 46 , 49 , 52 , 58 ] and partograph (n = 5) [ 24 , 25 , 29 , 40 , 54 , 55 ] (Tables 1 – 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…Meconium was mostly effective in predicting neonatal outcomes when combined with abnormal FHR [ 39 , 41 , 43 , 46 ]. Foetal scalp stimulation test (FSST) combined with IA were good predictors of perinatal outcomes: umbilical cord pH, Apgar score at one and five minutes, neonatal death and NICU admission [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…Meconium was associated with increased CS rates in India (clear liquor 17% vs meconium 33%) [ 39 , 58 ]. Nonreactive FSST detected by IA was associated with a significant increase in operative vaginal deliveries and CS rates [ 45 ]. Two clustered RCT on the partograph showed that training and the use of partograph led to significant reduction in length of labour and obstructed labour and oxytocin use but no changes in CS rate or maternal mortality [ 24 , 25 , 29 ].…”

Section: Resultsmentioning

confidence: 99%

“…The use of CTG required a high level of skills, resources, and costs [ 26 , 31 ]. Combining FHR monitoring with simpler adjunctive tests such as meconium, FAST, FSST, and FPO may provide non-invasive and reliable ways to confirm foetal wellbeing, avoiding unnecessary interventions [ 42 , 45 , 56 , 60 , 61 ].…”

Section: Resultsmentioning

confidence: 99%

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Strategies for intrapartum foetal surveillance in low- and middle-income countries: A systematic review

et al. 2018

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BackgroundThe majority of the five million perinatal deaths worldwide take place in low-resource settings. In contrast to high-resource settings, almost 50% of stillbirths occur intrapartum. The aim of this study was to synthesise available evidence of strategies for foetal surveillance in low-resource settings and associated neonatal and maternal outcomes, including barriers to their implementation.Methods and findingsThe review was registered with Prospero (CRD42016038679). Five databases were searched up to May 1st, 2016 for studies related to intrapartum foetal monitoring strategies and neonatal outcomes in low-resource settings.Two authors extracted data and assessed the risk of bias for each study. The outcomes were narratively synthesised. Strengths, weaknesses, opportunities and threats analysis (SWOT) was conducted for each monitoring technique to analyse their implementation.There were 37 studies included: five intervention and 32 observational studies. Use of the partograph improved perinatal outcomes. Intermittent auscultation with Pinard was associated with lowest rates of caesarean sections (10–15%) but with comparable perinatal outcomes to hand-held Doppler and Cardiotocography (CTG). CTG was associated with the highest rates of caesarean sections (28–34%) without proven benefits for perinatal outcome. Several tests on admission (admission tests) and adjunctive tests including foetal stimulation tests improved the accuracy of foetal heart rate monitoring in predicting adverse perinatal outcomes.ConclusionsFrom the available evidence, the partograph is associated with improved perinatal outcomes and is recommended for use with intermittent auscultation for intrapartum monitoring in low resource settings. CTG is associated with higher caesarean section rates without proven benefits for perinatal outcomes, and should not be recommended in low-resource settings. High-quality evidence considering implementation barriers and enablers is needed to determine the optimal foetal monitoring strategy in low-resource settings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Strategies for intrapartum foetal surveillance in low- and middle-income countries: A systematic review

et al. 2018

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“…Five of the 26 studies were from African countries [15,16,18,26,37], two from India [19,21], one from the Middle East [20], seven from Europe [4,22,23,27,29,34,38], seven from North America [24,28,[30][31][32][33]36] and four were from Australia/New Zealand [9,17,25,35]. The date range was from 1968 to 2019 (Table 1).…”

Section: Findings From the Studiesmentioning

confidence: 99%

Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy

Blix¹,

Maude²,

Hals³

et al. 2020

Preprint

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© 2019 Blix et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Intermittent auscultation (IA) is the technique of listening to and counting the fetal heart rate (FHR) for short periods during active labour and continuous cardiotocography (CTC) implies FHR monitoring for longer periods. Although the evidence suggests that IA is the best way to monitor healthy women at low risk of complications, there is no scientific evidence for the ideal device, timing, frequency and duration for IA. We aimed to give an overview of the field, identify and describe methods and practices for performing IA, map the evidence and accuracy for different methods of IA, and identify research gaps. Methods We conducted a systematic scoping review following the Joanna Briggs methodology. Med-line, EMBASE, Cinahl, Maternity & Infant Care, Cochrane Library, SveMed+, Web of Science, Scopus, Lilacs and African Journals Online were searched for publications up to January 2019. We did hand searches in relevant articles and databases. Studies from all countries, international guidelines and national guidelines from Denmark, United Kingdom, United States, New Zealand, Australia, The Netherlands, Sweden, Denmark, and Norway were included. We did quality assessment of the guidelines according to the AGREEMENT tool. We performed a meta-analysis assessing the effects of IA with a Doppler device vs. Pinard device using methods described in The Cochrane Handbook, and we performed an overall assessment of the summary of evidence using the GRADE approach. Results The searches generated 6408 hits of which 26 studies and 11 guidelines were included in the review. The studies described slightly different techniques for performing IA, and some did not provide detailed descriptions. Few of the studies provided details of normal and abnormal IA findings. All 11 guidelines recommended IA for low risk women, although they had slightly different recommendations on the frequency, timing, and duration for IA, and the FHR characteristics that should be observed. Four of the included studies, comprising 8436 women and their babies, were randomised controlled trials that evaluated the effect of IA with a Doppler device vs. a Pinard device. Abnormal FHRs were detected more often using the Doppler device than in those using the Pinard device (risk ratio 1.77; 95% confidence interval 1.29–2.43). There were no significant differences in any of the other maternal or neonatal outcomes. Four studies assessed the accuracy of IA findings. Normal FHR was easiest to identify correctly, whereas identifying periodic FHR patterns such as decelerations and saltatory patterns were more difficult. Conclusion Although IA is the recommended method, no trials have been published that evaluate protocols on how to perform it. Nor has any study assessed interrater agreements regarding interpretations of IA findings, and few have assessed to what degree clinicians can describe FHR patterns detected by IA. We found no evidence to recommend Doppler device instead of the Pinard for IA, or vice versa.

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Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace

East

Smyth

Leader

et al. 2013

Cochrane Database of Systematic Reviews

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There are currently no randomised controlled trials that address the safety and efficacy of VAS used to assess fetal well-being in labour in the presence of a nonreassuring CTG trace. Although VAS has been proposed as a simple, non-invasive tool for assessment of fetal well-being, there is insufficient evidence from randomised trials on which to base recommendations for use of VAS in the evaluation of fetal well-being in labour in the presence of a nonreassuring CTG trace.

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Fetal scalp stimulation test: An adjunct to intermittent auscultation in non‐reassuring fetal status during labor

Abstract: Non-reactive FSST is associated with adverse neonatal outcomes. The positive and negative predictive values of FSST to diagnose fetal cord blood pH < 7.20 during labor are 44% & 83%, respectively.

Cited by 10 publications

References 8 publications

Strategies for intrapartum foetal surveillance in low- and middle-income countries: A systematic review

Strategies for intrapartum foetal surveillance in low- and middle-income countries: A systematic review

Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy

Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace

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