assessed laboring women’s preferences, and found that a standard hand-held Doppler monitor was most acceptable, followed by the Pinard fetoscope, and finally the CTG. Nevertheless, the Pinard fetoscope is reported to be difficult to use, time-consuming, and painful for the mother, whereas the Doppler is believed to be less painful, easier to handle, and more reliable. Despite the findings in these studies, FHR assessments using fetoscopes have been the most common method of fetal monitoring in low-resource settings, because Dopplers are costly, and not usable in settings without reliable electricity or available batteries. The intermittent FHR monitoring using hand-held Doppler ultrasound found to detected more intrapartum FHR abnormalities as compared to the Pinard fetoscope. A recently Cochrane review found that continuous use of CTG did not improve perinatal survival rather contributed to the increased cesarean section births. These devices are costly and not available or feasible in low-resource settings. In high-income countries, continuous FHR monitoring is readily available, using high- technology devices such as a cardiotocograph (CTG). However, intermittent auscultation of FHR, if performed as often as recommended, is regarded as safe and effective in low-risk pregnancies and birth. These findings may reflect an inability to perform measurements correctly or as often as recommended using the fetoscope. In addition, as many as 40% of the babies who ended up as a fresh stillbirth had a normal or abnormal FHR on admission. Detection of an absent or abnormal FHR was associated with fresh stillbirth or birth asphyxia, with increased need of neonatal resuscitation. described the relationship between intermittent auscultation of FHR using a standard fetoscope and perinatal outcome. To prevent intrapartum asphyxia, early detection of fetal responses to fetal hypoxemia, as indicated by fetal heart rate (FHR) abnormalities, is crucial. These perinatal deaths may be due to hypoxic-ischemic encephalopathy because of interrupted placental blood flow. Globally, each year, an estimated 1.3 million babies are fresh stillbirths, and 700,000 early neonatal deaths occur due to birth asphyxia. Incidences of fresh stillbirths and intrapartum-related asphyxia are still unacceptably high in low-resource settings. Fetoscopes and Dopplers should be equally available during midwifery training and in clinical practice. Midwives’ preferences of FHR monitoring devices are influenced by the level of device training, experience with using a device, reliable measurements, and convenience and comfort during use. Dopplers need charging and do not cause pain, but provide limited privacy. 3) Convenience of use and comfort of a device Fetoscopes do not need charging, and while it is possible to “personalize/hide” the measurements, and may be painful for mothers. Fetoscope measurements are prone to human errors, and Doppler measurements are prone to instrumental errors. 2) Ability of the device to produce reliable measurements Using a fetoscope, one must listen for the heartbeat, count using a watch, and calculate, the Doppler provides both a display and sound of the FHR.
#HEART DOPPLER HOW TO#
The Doppler was recently introduced in the maternity ward, and midwives had insufficient training in how to use it. Three main themes emerged as factors perceived by midwives as influencing their preference 1) Sufficient training and experience with using a device Midwives had been using fetoscopes since their midwifery training, and they had vast experience using it. Qualitative content analysis was employed using NVivo 11.0. Five FGDs were conducted between December 2015 and February 2016. Focus group discussion (FGD) was used to collect data. Midwives who had worked for at least 6 months in the labor ward were recruited.
This study explored midwives’ perception of factors influencing their preference for using either a Pinard fetoscope or a FreePlay wind-up Doppler for intermittent FHR monitoring. However, in a rural Tanzanian hospital, midwives who had easy access to both devices mostly used fetoscope. The Doppler is thought to be more comfortable and effective compared to the fetoscope for assessing the fetal heart rate (FHR) during labor.
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