Fetal pulse oximetry for fetal assessment in labour

East, Christine E., Chan, Fung Yee, Colditz, Paul B. and Begg, Lisa (2004) Fetal pulse oximetry for fetal assessment in labour. The Cochrane Database of Systematic Reviews, 2 2: . doi:10.1002/14651858.CD004075.pub3


Author East, Christine E.
Chan, Fung Yee
Colditz, Paul B.
Begg, Lisa
Title Fetal pulse oximetry for fetal assessment in labour
Journal name The Cochrane Database of Systematic Reviews
ISSN 1464-780X
Publication date 2004
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD004075.pub3
Volume 2
Issue 2
Total pages 44
Editor Cochrane Pregnancy and Childbirth Group
Place of publication Chichester, U.K.
Publisher John Wiley & Sons
Collection year 2004
Language eng
Subject C1
321014 Obstetrics and Gynaecology
730217 Health status (e.g. indicators of well-being)
Formatted abstract
Background
Pulse oximetry could contribute to the evaluation of fetal well-being during labour.

Objectives
To compare the effectiveness and safety of fetal pulse oximetry with conventional surveillance techniques.

Search strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2006), MEDLINE (1994 to November 2006), EMBASE (1994 to November 2006) and Current Contents (1994 to November 2006).

Selection criteria
All published and unpublished randomised controlled trials that compared maternal and fetal outcomes when fetal pulse oximetry was used in labour, with or without concurrent use of conventional fetal surveillance, compared with using cardiotocography (CTG) alone.

Data collection and analysis
At least two independent authors performed data extraction. Analyses were performed on an intention-to-treat basis. We sought additional information from the investigators of three of the reported trials.

Main results
Five published trials comparing fetal pulse oximetry and CTG with CTG alone (or when fetal pulse oximetry values were blinded) were included. The published trials, with some unpublished data, reported on a total of 7424 pregnancies. Differing entry criteria necessitated separate analyses, rather than meta-analysis of all trials.

Four trials reported no significant differences in the overall caesarean section rate between those monitored with fetal oximetry and those not monitored with fetal pulse oximetry or for whom the fetal pulse oximetry results were masked. Neonatal seizures and hypoxic ischemic encephalopathy were rare. No studies reported details of assessment of long-term disability.

There was a statistically significant decrease in caesarean section for nonreassuring fetal status in the fetal pulse oximetry plus CTG group compared to the CTG group in two analyses: (i) gestation from 36 weeks with fetal blood sample (fetal blood sampling) not required prior to study entry (relative risk (RR) 0.68, 95% confidence interval (CI) 0.47 to 0.99); and (ii) when fetal blood sampling was required prior to study entry (RR 0.03, 95% CI 0.00 to 0.44). There was no statistically significant difference in caesarean section for dystocia when fetal pulse oximetry (fetal pulse oximetry) was added to CTG monitoring, compared with CTG monitoring alone, although the incidence rates varied between the trials.

Authors' conclusions
The data provide limited support for the use of fetal pulse oximetry when used in the presence of a nonreassuring CTG, to reduce caesarean section for nonreassuring fetal status. The addition of fetal pulse oximetry does not reduce overall caesarean section rates. A better method to evaluate fetal well-being in labour is required.
Keyword Medicine, General & Internal
Randomized Controlled-trial
Heart-rate Patterns
Cost-effectiveness Analysis
Foremost Trial
Oxygen-saturation
Womens Evaluations
Intrapartum Management
Neonatal Outcomes
Alternative Modes
Predictive-value
Q-Index Code C1

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
2005 Higher Education Research Data Collection
School of Medicine Publications
School of Nursing, Midwifery and Social Work Publications
 
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Created: Wed, 15 Aug 2007, 03:33:51 EST