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

Abstract

<jats:p>© 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 &amp; 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.</jats:p>

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

“…Our scoping review has strengths and limitations. We published the study protocol before we initiated the literature searches [10]. We did broad literature searches, and it is unlikely that we missed significant publications.…”

“…A study protocol was developed and published before initiating the literature search [10]. We then conducted a scoping review following the methods described by the Joanna Briggs Institute [11].…”

Authors' reply re: Intrapartum‐related perinatal deaths in births planned in midwifery‐led settings in Great Britain: findings and recommendations from the ESMiE confidential enquiry

“…We acknowledge, as Mr Sholapurkar points out, that there is a limited evidence base for some of the practical aspects of intermittent auscultation, including the ideal device, timing, frequency and duration of auscultation 5 . Research in this area is overdue and would inform ongoing fetal monitoring quality improvement initiatives and national guidance.…”

A Multimethod Improvement Project to Strengthen Intermittent Auscultation Practice Among Nurse‐Midwives and Nurses

“…Although all major professional organizations in perinatal care support the use of IA for individuals in labor who are at low risk for fetal acidemia, there is no consensus on how low risk is defined or on the risk factors for which EFM may improves outcomes. [9][10][11] In addition, research evidence has not established the most effective and reliable auscultation methods, such as frequency and duration of listening and techniques for interpreting and documenting auscultation findings, 12,13 and few standardized IA-focused training resources exist for perinatal care providers. 1 As a result, hospitals, birth centers, and home birth practices typically develop their own standards for IA technique, practice, and training approaches, resulting in the potential for significant variation in skill and practice across providers and care settings.…”