Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
PLoS One. 2018 Oct 26;13(10):e0206295. doi: 10.1371/journal.pone.0206295. eCollection 2018.
The majority of the five million perinatal deaths worldwide take place in low-resource settings. In contrast to high-resource settings, almost 50% of stillbirths occur intrapartum. The aim of this study was to synthesise available evidence of strategies for foetal surveillance in low-resource settings and associated neonatal and maternal outcomes, including barriers to their implementation.
The review was registered with Prospero (CRD42016038679). Five databases were searched up to May 1st, 2016 for studies related to intrapartum foetal monitoring strategies and neonatal outcomes in low-resource settings. Two authors extracted data and assessed the risk of bias for each study. The outcomes were narratively synthesised. Strengths, weaknesses, opportunities and threats analysis (SWOT) was conducted for each monitoring technique to analyse their implementation. There were 37 studies included: five intervention and 32 observational studies. Use of the partograph improved perinatal outcomes. Intermittent auscultation with Pinard was associated with lowest rates of caesarean sections (10-15%) but with comparable perinatal outcomes to hand-held Doppler and Cardiotocography (CTG). CTG was associated with the highest rates of caesarean sections (28-34%) without proven benefits for perinatal outcome. Several tests on admission (admission tests) and adjunctive tests including foetal stimulation tests improved the accuracy of foetal heart rate monitoring in predicting adverse perinatal outcomes.
From the available evidence, the partograph is associated with improved perinatal outcomes and is recommended for use with intermittent auscultation for intrapartum monitoring in low resource settings. CTG is associated with higher caesarean section rates without proven benefits for perinatal outcomes, and should not be recommended in low-resource settings. High-quality evidence considering implementation barriers and enablers is needed to determine the optimal foetal monitoring strategy in low-resource settings.
全世界五百万例围产儿死亡中，大多数发生在资源匮乏的环境中。与资源丰富的环境相比，近 50%的死产发生在分娩过程中。本研究旨在综合现有资源匮乏环境中胎儿监护策略及相关新生儿和产妇结局的证据，包括实施障碍。
本综述在 PROSPERO（CRD42016038679）进行了注册。截至 2016 年 5 月 1 日，我们在五个数据库中检索了与资源匮乏环境中分娩时胎儿监测策略和新生儿结局相关的研究。两名作者提取数据并对每项研究的偏倚风险进行评估。结果进行了叙述性综合。对每种监测技术进行了优势、劣势、机会和威胁分析（SWOT），以分析其实施情况。共纳入 37 项研究：5 项干预研究和 32 项观察性研究。使用产程图改善了围产结局。间断听诊加皮纳（Pinard）听诊与最低的剖宫产率（10-15%）相关，但与手持多普勒和胎心监护（CTG）的围产结局相当。CTG 与最高的剖宫产率（28-34%）相关，但对围产结局无明显益处。几项入院时检查（入院检查）和附加检查，包括胎儿刺激试验，提高了胎儿心率监测预测不良围产结局的准确性。
现有证据表明，产程图与改善围产结局相关，建议在资源匮乏环境中与间断听诊联合使用，用于分娩期间的胎儿监测。CTG 与较高的剖宫产率相关，但对围产结局无明显益处，因此不建议在资源匮乏的环境中使用。需要高质量的证据来确定资源匮乏环境中最佳的胎儿监测策略，包括实施障碍和促进因素。
