Effectiveness of intrapartum fetal surveillance: Meta-analys
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Fetal surveillance is routinely offered to patients in labor to reduce the risk of adverse neonatal outcomes, as well as the risk of unnecessary emergency cesarean deliveries and other maternal interventions. In a recent study, researchers have reported that intermittent auscultation outperforms other fetal surveillance methods and improves maternal and neonatal outcomes.

Researchers conducted a systematic review and network meta-analysis to evaluate the effectiveness of different types of fetal surveillance.

Investigators searched MEDLINE, Embase, and CENTRAL, for randomized trials evaluating any intrapartum fetal surveillance method. They performed a network meta-analysis within a frequentist framework. They assessed the quality and network inconsistency of trials. And reported primarily on intrapartum emergency cesarean deliveries and other secondary maternal and neonatal outcomes using risk ratios (RRs) and 95% confidence intervals (CIs).

33 trials (118 863 patients) were included evaluating intermittent auscultation with Pinard stethoscope/handheld Doppler (IA), cardiotocography (CTG), computerized cardiotocography (cCTG), CTG with fetal scalp lactate (CTG-lactate), CTG with fetal scalp pH analysis (CTG-FBS), CTG with fetal pulse oximetry (FPO-CTG), CTG with fetal heart electrocardiogram (CTG-STAN) and their combinations.

--Intermittent auscultation reduced the risk of emergency cesarean deliveries compared with other types of surveillance, except STAN-CTG-FBS.

--There was a similar reduction observed for emergency cesarean deliveries for fetal distress.

--None of the evaluated methods was associated with a reduced risk of neonatal acidemia, neonatal unit admissions, Apgar scores, or perinatal death.

Conclusively, compared with other types of fetal surveillance, intermittent auscultation seems to reduce emergency cesarean deliveries in labor without increasing adverse neonatal and maternal outcomes.

Source: https://www.cmaj.ca/content/193/14/E468