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

Ellen Blix, Robyn Maude, Elisabeth Hals, Sezer Kisa, Elisabeth Karlsen, Ellen Aagaard Nohr, Ank de Jonge, Helena Lindgren, Soo Downe, Liv Merete Reinar, Maralyn Foureur, Aase Serine Devold Pay, Anne Kaasen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Resumé

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. Medline, 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.

OriginalsprogEngelsk
Artikelnummere0219573
TidsskriftPLOS ONE
Vol/bind14
Udgave nummer7
Antal sider21
ISSN1932-6203
DOI
StatusUdgivet - 10. jul. 2019

Fingeraftryk

Fetal monitoring
Fetal Monitoring
systematic review
labor
heart rate
Personnel
monitoring
Fetal Heart Rate
Equipment and Supplies
Denmark
Timing devices
methodology
Guidelines
child care
Deceleration
duration
infants
relative risk
meta-analysis
United Kingdom

Citer dette

Blix, Ellen ; Maude, Robyn ; Hals, Elisabeth ; Kisa, Sezer ; Karlsen, Elisabeth ; Nohr, Ellen Aagaard ; de Jonge, Ank ; Lindgren, Helena ; Downe, Soo ; Reinar, Liv Merete ; Foureur, Maralyn ; Pay, Aase Serine Devold ; Kaasen, Anne. / Intermittent auscultation fetal monitoring during labour : A systematic scoping review to identify methods, effects, and accuracy. I: PLOS ONE. 2019 ; Bind 14, Nr. 7.
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title = "Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy",
abstract = "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. Medline, 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.",
author = "Ellen Blix and Robyn Maude and Elisabeth Hals and Sezer Kisa and Elisabeth Karlsen and Nohr, {Ellen Aagaard} and {de Jonge}, Ank and Helena Lindgren and Soo Downe and Reinar, {Liv Merete} and Maralyn Foureur and Pay, {Aase Serine Devold} and Anne Kaasen",
year = "2019",
month = "7",
day = "10",
doi = "10.1371/journal.pone.0219573",
language = "English",
volume = "14",
journal = "P L o S One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "7",

}

Blix, E, Maude, R, Hals, E, Kisa, S, Karlsen, E, Nohr, EA, de Jonge, A, Lindgren, H, Downe, S, Reinar, LM, Foureur, M, Pay, ASD & Kaasen, A 2019, 'Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy', PLOS ONE, bind 14, nr. 7, e0219573. https://doi.org/10.1371/journal.pone.0219573

Intermittent auscultation fetal monitoring during labour : A systematic scoping review to identify methods, effects, and accuracy. / Blix, Ellen; Maude, Robyn; Hals, Elisabeth; Kisa, Sezer; Karlsen, Elisabeth; Nohr, Ellen Aagaard; de Jonge, Ank; Lindgren, Helena; Downe, Soo; Reinar, Liv Merete; Foureur, Maralyn; Pay, Aase Serine Devold; Kaasen, Anne.

I: PLOS ONE, Bind 14, Nr. 7, e0219573, 10.07.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Intermittent auscultation fetal monitoring during labour

T2 - A systematic scoping review to identify methods, effects, and accuracy

AU - Blix, Ellen

AU - Maude, Robyn

AU - Hals, Elisabeth

AU - Kisa, Sezer

AU - Karlsen, Elisabeth

AU - Nohr, Ellen Aagaard

AU - de Jonge, Ank

AU - Lindgren, Helena

AU - Downe, Soo

AU - Reinar, Liv Merete

AU - Foureur, Maralyn

AU - Pay, Aase Serine Devold

AU - Kaasen, Anne

PY - 2019/7/10

Y1 - 2019/7/10

N2 - 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. Medline, 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.

AB - 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. Medline, 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.

U2 - 10.1371/journal.pone.0219573

DO - 10.1371/journal.pone.0219573

M3 - Journal article

C2 - 31291375

VL - 14

JO - P L o S One

JF - P L o S One

SN - 1932-6203

IS - 7

M1 - e0219573

ER -