Almost 3 million newborn deaths occur globally each year, and many of these deaths are related to labor complications. In addition, almost 3 million stillbirths occur globally each year, nearly half of them during labor. More than 80% of all these deaths take place in low-income countries, with 50% in Sub-Saharan Africa, where the mismatch between health service provision and needs is substantial.
There is a strong association between abnormal fetal heart rate and labor-related deaths. Therefore, optimal fetal heart rate monitoring can help health care workers identify babies at risk and take appropriate actions to save lives.
Difficult in congested maternity wards
Traditionally, health workers in low-resource countries have used a Pinard stethoscope to auscultate fetal heart rate. This is the most used tool but can be difficult in congested maternity wards with a high patient/health worker ratio compromising quality of care provision.
This PhD is part of the Safer Births innovation and research project, and the studies were conducted at Muhimbili National Hospital and Temeke Regional Referral Hospital in Dar es Salaam, Tanzanian. The aim was to compare the effectiveness of different fetal heart rate monitoring devices and the associated improvement in quality of care during labor. Two randomized trials were conducted; first testing Pinard stethoscope against Hand-held Doppler, then hand-held Doppler against Moyo (a new continuous fetal heart rate monitor developed by Laerdal Global Health). Finally, a before/after implementation study of Moyo was undertaken.
More frequent detection of abnormal heart rate
This PhD project shows that the Hand-held Doppler was superior to the Pinard stethoscope, and Moyo was superior to the Hand-held Doppler in the detection of abnormal fetal heart rate. Implementation of Moyo in the referral hospital led to earlier and more frequent detection of abnormal fetal heart rate, associated with improved quality of care during labor. Studies coupled with timely obstetric responses and powered to detect differences in perinatal outcomes are recommended.
Safer Births is an international collaboration led by Stavanger University Hospital/SAFER and Laerdal Global Health. The main funding sources are the Norwegian Research Council, the Laerdal Foundation, and the Saving Lives at Birth Grand Challenge.