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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. Nurs Womens Health 2024; 28:e1-e39. [PMID: 38363259 DOI: 10.1016/j.nwh.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(23)00279-4. [PMID: 38363241 DOI: 10.1016/j.jogn.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Skytte TB, Holm-Hansen CC, Ali SM, Ame S, Molenaar J, Greisen G, Poulsen A, Sorensen JL, Lund S. Risk factors of stillbirths in four district hospitals on Pemba Island, Tanzania: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:288. [PMID: 37101264 PMCID: PMC10131471 DOI: 10.1186/s12884-023-05613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND More than 2 million third-trimester stillbirths occur yearly, most of them in low- and middle-income countries. Data on stillbirths in these countries are rarely collected systematically. This study investigated the stillbirth rate and risk factors associated with stillbirth in four district hospitals in Pemba Island, Tanzania. METHODS A prospective cohort study was completed between the 13th of September and the 29th of November 2019. All singleton births were eligible for inclusion. Events and history during pregnancy and indicators for adherence to guidelines were analysed in a logistic regression model that identified odds ratios [OR] with a 95% confidence interval [95% CI]. RESULTS A stillbirth rate of 22 per 1000 total births in the cohort was identified; 35.5% were intrapartum stillbirths (total number of stillbirths in the cohort, n = 31). Risk factors for stillbirth were breech or cephalic malpresentation (OR 17.67, CI 7.5-41.64), decreased or no foetal movements (OR 2.6, CI 1.13-5.98), caesarean section [CS] (OR 5.19, CI 2.32-11.62), previous CS (OR 2.63, CI 1.05-6.59), preeclampsia (OR 21.54, CI 5.28-87.8), premature rupture of membranes or rupture of membranes 18 h before birth (OR 2.5, CI 1.06-5.94) and meconium stained amniotic fluid (OR 12.03, CI 5.23-27.67). Blood pressure was not routinely measured, and 25% of women with stillbirths with no registered foetal heart rate [FHR] at admission underwent CS. CONCLUSIONS The stillbirth rate in this cohort was 22 per 1000 total births and did not fulfil the Every Newborn Action Plan's goal of 12 stillbirths per 1000 total births in 2030. Awareness of risk factors associated with stillbirth, preventive interventions and improved adherence to clinical guidelines during labour, and hence improved quality of care, are needed to decrease the stillbirth rate in resource-limited settings.
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Affiliation(s)
- Tine Bruhn Skytte
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark.
| | - Charlotte Carina Holm-Hansen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
| | | | - Shaali Ame
- Public Health Laboratory, Ivo de Carneri, Pemba, Tanzania
| | - Jil Molenaar
- Reproductive and Maternal Health Research Group, Public Health Department, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Family Medicine and Population Health (FAMPOP), Faculty of Medical Sciences, University of Antwerp, Antwerp, Belgium
| | - Gorm Greisen
- Department of Neonatology, Juliane Marie Center, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
| | - Jette Led Sorensen
- Juliane Marie Centre for Children, Women and Reproduction, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stine Lund
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Neonatology, Juliane Marie Center, University Hospital Copenhagen, Copenhagen, Denmark
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Evans M, Corden MH, Crehan C, Fitzgerald F, Heys M. Refining clinical algorithms for a neonatal digital platform for low-income countries: a modified Delphi technique. BMJ Open 2021; 11:e042124. [PMID: 34006538 PMCID: PMC8130744 DOI: 10.1136/bmjopen-2020-042124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To determine whether a panel of neonatal experts could address evidence gaps in local and international neonatal guidelines by reaching a consensus on four clinical decision algorithms for a neonatal digital platform (NeoTree). DESIGN Two-round, modified Delphi technique. SETTING AND PARTICIPANTS Participants were neonatal experts from high-income and low-income countries (LICs). METHODS This was a consensus-generating study. In round 1, experts rated items for four clinical algorithms (neonatal sepsis, hypoxic ischaemic encephalopathy, respiratory distress of the newborn, hypothermia) and justified their responses. Items meeting consensus for inclusion (≥80% agreement) were incorporated into the algorithms. Items not meeting consensus were either excluded, included following revisions or included if they contained core elements of evidence-based guidelines. In round 2, experts rated items from round 1 that did not reach consensus. RESULTS Fourteen experts participated in round 1, 10 in round 2. Nine were from high-income countries, five from LICs. Experts included physicians and nurse practitioners with an average neonatal experience of 20 years, 12 in LICs. After two rounds, a consensus was reached on 43 of 84 items (52%). Per experts' recommendations, items in line with local and WHO guidelines yet not meeting consensus were still included to encourage consistency for front-line healthcare workers. As a result, the final algorithms included 53 items (62%). CONCLUSION Four algorithms in a neonatal digital platform were reviewed and refined by consensus expert opinion. Revisions to NeoTree will be made in response to these findings. Next steps include clinical validation of the algorithms.
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Affiliation(s)
- Mari Evans
- UCL Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
| | - Mark H Corden
- Division of Hospital Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Caroline Crehan
- UCL Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
| | - Felicity Fitzgerald
- UCL Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
| | - Michelle Heys
- UCL Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
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5
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Wright A, Nassar AH, Visser G, Ramasauskaite D, Theron G. FIGO good clinical practice paper: management of the second stage of labor. Int J Gynaecol Obstet 2021; 152:172-181. [PMID: 33340411 PMCID: PMC7898872 DOI: 10.1002/ijgo.13552] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/24/2020] [Accepted: 12/17/2020] [Indexed: 11/08/2022]
Abstract
This good clinical practice paper provides an overview of the current evidence around second stage care, highlighting the challenges and the importance of maintaining high-quality, safe, and respectful care in all settings. It includes a series of recommendations based on best available evidence regarding length of second stage, judicious use of episiotomy, and the importance of competent attendants and adequate resource to facilitate all aspects of second stage management, from physiological birth to assisted vaginal delivery and cesarean at full dilatation. The second stage of labor is potentially the most dangerous time for the baby and can have significant consequences for the mother, including death or severe perineal trauma or fistula, especially where there are failures to recognize and repair. This paper sets out principles of care, including the vital role of skilled birth attendants and birth companions, and the importance of obstetricians and midwives working together effectively and speaking with one voice, whether to women or to policy makers. The optimization of high-quality, safe, and personalized care in the second stage of labor for all women globally can only be achieved by appropriate attention to the training of birth attendants, midwives, and obstetricians. FIGO is committed to this aim alongside the WHO, ICM, and all FIGO's 132 member societies.
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Affiliation(s)
- Alison Wright
- Department of Obstetrics and GynaecologyRoyal Free London Teaching HospitalLondonUK
| | - Anwar H. Nassar
- Department of Obstetrics and GynecologyAmerican University of Beirut Medical CenterBeirutLebanon
| | - Gerry Visser
- Department of ObstetricsUniversity Medical CenterUtrechtthe Netherlands
| | - Diana Ramasauskaite
- Center of Obstetrics and GynaecologyVilnius University Faculty of MedicineVilniusLithuania
| | - Gerhard Theron
- Department of Obstetrics and GynaecologyFaculty of Medicine and Health SciencesUniversiteit StellenboschStellenboschSouth Africa
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Valderrama CE, Ketabi N, Marzbanrad F, Rohloff P, Clifford GD. A review of fetal cardiac monitoring, with a focus on low- and middle-income countries. Physiol Meas 2020; 41:11TR01. [PMID: 33105122 PMCID: PMC9216228 DOI: 10.1088/1361-6579/abc4c7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is limited evidence regarding the utility of fetal monitoring during pregnancy, particularly during labor and delivery. Developed countries rely on consensus ‘best practices’ of obstetrics and gynecology professional societies to guide their protocols and policies. Protocols are often driven by the desire to be as safe as possible and avoid litigation, regardless of the cost of downstream treatment. In high-resource settings, there may be a justification for this approach. In low-resource settings, in particular, interventions can be costly and lead to adverse outcomes in subsequent pregnancies. Therefore, it is essential to consider the evidence and cost of different fetal monitoring approaches, particularly in the context of treatment and care in low-to-middle income countries. This article reviews the standard methods used for fetal monitoring, with particular emphasis on fetal cardiac assessment, which is a reliable indicator of fetal well-being. An overview of fetal monitoring practices in low-to-middle income counties, including perinatal care access challenges, is also presented. Finally, an overview of how mobile technology may help reduce barriers to perinatal care access in low-resource settings is provided.
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Affiliation(s)
- Camilo E Valderrama
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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van Duinen AJ, Westendorp J, Kamara MM, Forna F, Hagander L, Rijken MJ, Leather AJM, Wibe A, Bolkan HA. Perinatal outcomes of cesarean deliveries in Sierra Leone: A prospective multicenter observational study. Int J Gynaecol Obstet 2020; 150:213-221. [PMID: 32306384 DOI: 10.1002/ijgo.13172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/08/2020] [Accepted: 04/15/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To analyze the indications for cesarean deliveries and factors associated with adverse perinatal outcomes in Sierra Leone. METHODS Between October 2016 and May 2017, patients undergoing cesarean delivery performed by medical doctors and associate clinicians in nine hospitals were included in a prospective observational study. Data were collected perioperatively, at discharge, and during home visits after 30 days. RESULTS In total, 1274 cesarean deliveries were included of which 1099 (86.3%) were performed as emergency surgery. Of the 1376 babies, 261 (19.0%) were perinatal deaths (53 antepartum stillbirths, 155 intrapartum stillbirths, and 53 early neonatal deaths). Indications with the highest perinatal mortality were uterine rupture (45 of 55 [81.8%]), abruptio placentae (61 of 85 [71.8%]), and antepartum hemorrhage (8 of 15 [53.3%]). In the group with cesarean deliveries performed for obstructed and prolonged labor, a partograph was filled out for 212 of 425 (49.9%). However, when completed, babies had 1.81-fold reduced odds for perinatal death (95% confidence interval 1.03-3.18, P-value 0.041). CONCLUSION Cesarean deliveries in Sierra Leone are associated with an exceptionally high perinatal mortality rate of 190 per 1000 births. Late presentation in the facilities and lack of adequate fetal monitoring may be contributing factors.
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Affiliation(s)
- Alex J van Duinen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Josien Westendorp
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Michael M Kamara
- Ministry of Health and Sanitation, Freetown, Sierra Leone.,College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Fatu Forna
- World Health Organization, Freetown, Sierra Leone
| | - Lars Hagander
- Surgery and Public Health, Department of Clinical Sciences Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Marcus J Rijken
- University Medical Centre Utrecht, Utrecht, The Netherlands.,The Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Andrew J M Leather
- King's Centre for Global Health and Health Partnerships, King's College London, London, UK
| | - Arne Wibe
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Håkon A Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
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8
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Löwensteyn YN, Housseine N, Masina T, Browne JL, Rijken MJ. Birth asphyxia following delayed recognition and response to abnormal labour progress and fetal distress in a 31-year-old multiparous Malawian woman. BMJ Case Rep 2019; 12:e227973. [PMID: 31511259 PMCID: PMC6738677 DOI: 10.1136/bcr-2018-227973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2019] [Indexed: 12/12/2022] Open
Abstract
Reducing neonatal mortality is one of the targets of Sustainable Development Goal 3 on good health and well-being. The highest rates of neonatal death occur in sub-Saharan Africa. Birth asphyxia is one of the major preventable causes. Early detection and timely management of abnormal labour progress and fetal compromise are critical to reduce the global burden of birth asphyxia. Labour progress, maternal and fetal well-being are assessed using the WHO partograph and intermittent fetal heart rate monitoring. However, in low-resource settings adherence to labour guidelines and timely response to arising labour complications is generally poor. Reasons for this are multifactorial and include lack of resources and skilled health care staff. This case study in a Malawian hospital illustrates how delayed recognition of abnormal labour and prolonged decision-to-delivery interval contributed to birth asphyxia, as an example of many delivery rooms in low-income country settings.
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Affiliation(s)
- Yvette N Löwensteyn
- Department of Vrouw & Baby, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Natasha Housseine
- Department of Vrouw & Baby, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania
| | - Thokozani Masina
- Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Joyce L Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Marcus J Rijken
- Department of Vrouw & Baby, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands
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9
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Balikuddembe MS, Tumwesigye NM, Wakholi PK, Tylleskär T. Expert perspectives on essential parameters to monitor during childbirth in low resource settings: a Delphi study in sub-Saharan Africa. Reprod Health 2019; 16:119. [PMID: 31382989 PMCID: PMC6683469 DOI: 10.1186/s12978-019-0786-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 07/30/2019] [Indexed: 12/16/2022] Open
Abstract
Objective There is no consensus on the essential parameters to monitor during childbirth, when to start, and the rate of monitoring them. User disagreement contributes to inconsistent use of the twelve-item modified World Health Organization partograph that is started when the cervix is at least 4 cm dilated. The inconsistent use is associated with poor outcomes at birth. Our objective was to identify the perspectives of childbirth experts on what and when to routinely monitor during childbirth in low resource settings as we develop a more acceptable childbirth clinical decision support tool. Method We carried out a Delphi study with two survey rounds in early 2018. The online questionnaire covered the partograph items like foetal heart, cervical dilation, and blood pressure, and their monitoring rates. We invited panellists with experience of childbirth care in sub-Saharan Africa. Consensus was pre-set at 70% panellists rating a parameter and we gathered some qualitative reasons for choices. Results We analysed responses of 76 experts from 13 countries. There was consensus on six important parameters including foetal heart rate, amniotic fluid clearness, cervical dilation, strength of uterine contractions, maternal pulse, and blood pressure. Two in three experts expressed support for changing the monitoring intervals for some parameters in the partograph. 63% experts would raise the partograph starting point while 58% would remove some items from it. Consensus was reached on monitoring the cervical dilation at 4-hourly intervals and there was agreement on monitoring the foetal heart rate one-hourly. However, other parameters only showed majority intervals and without reaching agreement scores. The suggested intervals were two-hourly for strength of uterine contractions, and four-hourly for amniotic fluid thickness, maternal pulse and blood pressure. The commonest reason for their opinions was the more demanding working conditions. Conclusion There was agreement on six partograph items being essential for routine monitoring at birth, but the frequency of monitoring could be changed. To increase acceptability, revisions to birth monitoring guidelines have to be made in consideration of opinions and working conditions of several childbirth experts in low resource settings. Electronic supplementary material The online version of this article (10.1186/s12978-019-0786-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael S Balikuddembe
- Centre for International Health, University of Bergen, P O Box 7800, 5020, Bergen, Norway. .,Department of Obstetrics and Gynaecology, Mulago National Referral and Teaching Hospital, P O Box 7051, Kampala, Uganda.
| | - Nazarius M Tumwesigye
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P O Box 7072, Kampala, Uganda
| | - Peter K Wakholi
- College of Computing and Information Science, Makerere University Kampala, P O Box 7062, Kampala, Uganda
| | - Thorkild Tylleskär
- Centre for International Health, University of Bergen, P O Box 7800, 5020, Bergen, Norway
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Visser GH, Stones W, Nassar A, Ayres‐de‐Campos D, Barnea ER, Bernis L, Di Renzo GC, Escobar Vidarte MF, Lloyd I, Nicholson W, Shah P, Sun L, Theron GB, Walani S. Framework for safe delivery: A call to action. Int J Gynaecol Obstet 2019; 146:1-2. [DOI: 10.1002/ijgo.12840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gerard H.A. Visser
- Department of Obstetrics University Medical Center Utrecht Utrecht The Netherlands
| | - William Stones
- Departments of Public Health and Obstetrics & Gynaecology Malawi College of Medicine Blantyre Malawi
| | - Anwar Nassar
- Department of Obstetrics and Gynecology American University of Beirut Medical Center Beirut Lebanon
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11
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Rivenes Lafontan S, Kidanto HL, Ersdal HL, Mbekenga CK, Sundby J. Perceptions and experiences of skilled birth attendants on using a newly developed strap-on electronic fetal heart rate monitor in Tanzania. BMC Pregnancy Childbirth 2019; 19:165. [PMID: 31077139 PMCID: PMC6511185 DOI: 10.1186/s12884-019-2286-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 04/12/2019] [Indexed: 12/16/2022] Open
Abstract
Background Regular fetal heart rate monitoring during labor can drastically reduce fresh stillbirths and neonatal mortality through early detection and management of fetal distress. Fetal monitoring in low-resource settings is often inadequate. An electronic strap-on fetal heart rate monitor called Moyo was introduced in Tanzania to improve intrapartum fetal heart rate monitoring. There is limited knowledge about how skilled birth attendants in low-resource settings perceive using new technology in routine labor care. This study aimed to explore the attitude and perceptions of skilled birth attendants using Moyo in Dar es Salaam, Tanzania. Methods A qualitative design was used to collect data. Five focus group discussions and 10 semi-structured in-depth interviews were carried out. In total, 28 medical doctors and nurse/midwives participated in the study. The data was analyzed using qualitative content analysis. Results The participants in the study perceived that the device was a useful tool that made it possible to monitor several laboring women at the same time and to react faster to fetal distress alerts. It was also perceived to improve the care provided to the laboring women. Prior to the introduction of Moyo, the participants described feeling overwhelmed by the high workload, an inability to adequately monitor each laboring woman, and a fear of being blamed for negative fetal outcomes. Challenges related to use of the device included a lack of adherence to routines for use, a lack of clarity about which laboring women should be monitored continuously with the device, and misidentification of maternal heart rate as fetal heart rate. Conclusion The electronic strap-on fetal heart rate monitor, Moyo, was considered to make labor monitoring easier and to reduce stress. The study findings highlight the importance of ensuring that the device’s functions, its limitations and its procedures for use are well understood by users. Electronic supplementary material The online version of this article (10.1186/s12884-019-2286-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sara Rivenes Lafontan
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Forskningsveien 3A, 0373, Oslo, Norway.
| | - Hussein L Kidanto
- Medical College, East Africa, Aga Khan University, Dar es Salaam, Tanzania.,Department of Research, Stavanger University Hospital, Postboks 8100, 4068, Stavanger, Norway
| | - Hege L Ersdal
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Postboks 8100, 4068, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Columba K Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Johanne Sundby
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Forskningsveien 3A, 0373, Oslo, Norway
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12
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Antenatal electronic fetal heart monitoring for extremely and very preterm newborns. GINECOLOGIA.RO 2019. [DOI: 10.26416/gine.26.4.2019.2705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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