Intermittent Auscultation for the Intrapartum Assessment of Fetal Well‐being in Western Australia

Abstract

In May 1995, in response to a decision of the Perinatal and Infant Mortality Committee of Western Australia, a survey of Western Australian hospitals was performed to ascertain what policies were in use for the monitoring of the fetal heart rate in labour and what proportion of these hospitals had access to electronic monitoring by cardiotocography. A response was received from 96% of the surveyed hospitals. More than half the births in this State (13,950 of 25,238) were monitored in labour using intermittent auscultation as the primary test; 7.5% of Western Australian births each year occurred in hospitals in which electronic monitoring was not available. Fewer than 50% of hospitals had written protocols describing the method of auscultation of the fetal heart during labour, the indications to contact a doctor or the management of fetal distress. The protocols which did exist displayed considerable variation in the recommended frequency of intermittent auscultation. The lack of standard practice in this field probably results from uncertainties in the literature. Intermittent auscultation has not been subjected to rigorous scientific evaluation as a screening tool and guidelines documenting ideal auscultatory practices need to balance the precision of electronic monitoring and freedom from intervention. Based on this compromise and existing evidence, a protocol for intermittent auscultation in normal labour is proposed.

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

“…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).…”

“…The Pinard fetoscope, DeLee fetoscope, and Doppler device (battery or wind-up) were the common tools used to perform IA. Some studies did not specify the device [21,22,25,[31][32][33]35], and two studies just called it "a stethoscope" [19,29]. There were no detailed descriptions of Pinard or DeLee fetoscopes in the studies in which they were used [4, 9, 15-18, 26, 28, 34, 38].…”

“…During the first stage of labour, the frequency of auscultation was described as either every 15 min [4,19,21,27,28,[31][32][33][34]38], 15-30 min [9,17] or 30 min [15,16,18,37]. One study reported the frequency as every 30 min in low-risk women and every 15-30 min in women at higher risk [25]. Another study reported IA frequency at every 30 min until 5-cm cervical dilatation and then every 15 min [29].…”

Strengthening field-based training in low and middle-income countries to build public health capacity: Lessons from Australia's Master of Applied Epidemiology program

“…Among the key goals on the network in 1991 were the revitalisation of systems of surveillance and outbreak response, and evidence-based policy development at state and national levels. Vietnam tion of the co-authored publications mentioned elsewhere in this paper are cited [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]. The directors have a vested interest in identifying and implementing solutions.…”

“…In a globalised world, these contributions need to be scaled up. [42,43,51], mortality in internally displaced populations [50], maternal and child health [37,39,53], and diabetes [46]. Some of the points we have argued in support of the MAE model, particularly the engagement of interested and supportive academic supervisors, are used within the Public Health Schools Without Walls for generalist public health training.…”