Fetal monitoring in women with low risk of complications (LISTEN)

The aim of intrapartum fetal monitoring is to identify fetuses threatened by asphyxia, and to enable timely interventions to prevent injuries.

Norwegian and international guidelines recommend monitoring with intermittent auscultation in healthy women with low risk for complications, and continuous electronic monitoring using cardiotocography (CTG) in women with high risk for complications.

Intermittent auscultation is the technique of listening to and counting the fetal heart rate for short periods, usually every 15 to 30 minutes. It is usually performed by using a Pinard fetoscope, or a hand-held doppler device.

Current evidence states that CTG monitoring compared to IA is associated with a higher risk for caesarean sections and instrumental deliveries. It is also associated with reduced risk for neonatal seizures, but no clear differences in mortality rates, cerebral palsy or other measures of fetal wellbeing.

Despite guideline recommendations and the current body of evidence, CTG monitoring is often used when monitoring women with low risk for complications. This implies that skills to perform intermittent auscultation – especially with the Pinard – are decreased in midwifery practice.

Following the principles of “Needs-Led-Research”, and other approaches, the LISTEN project has developed research questions relevant for users and aims to fill research gaps within the field.

To identify relevant research questions, we performed a systematic scoping review about intermittent auscultation, mapped fetal monitoring guidelines and practice in Norwegian maternity units, performed group discussions with users (women, midwives, and obstetricians) and a survey to users.

The LISTEN project is divided into two parts, and with two PhD candidates, Kristin Jerve Aanstad and Christina Hernandez Engelhart.

LISTEN’s overall aim is to provide more knowledge about intrapartum fetal monitoring in women with low risk for complications and promote evidence-based practices.

Specific aims for Aanstad

• Investigate different methods used for intrapartum fetal monitoring in Norway during 2019-2020, including how they vary by birth unit, region, and the woman’s risk status.
• Investigate the trends in proportion of women assessed as low risk, with uncomplicated deliveries without interventions, and thereby suitable for intrapartum intermittent auscultation monitoring, through a 20-year period.
• Explore barriers and facilitators among midwives for performing intrapartum intermittent auscultation in healthy women with low risk for complications.

Specific aims for Engelhart

• Investigate the reliability and agreement in intrapartum fetal heart rate monitoring interpretation through a systematic review.
• Investigate the reliability and agreement in intrapartum intermittent auscultation interpretation when using a handheld doppler device.
• Explore the practice, skills, and experiences of midwives familiar with the Pinard fetoscope for intrapartum fetal monitoring.