Strategies for intrapartum foetal surveillance in low- and middle-income countries: A systematic review
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BACKGROUND: 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. METHODS AND FINDINGS: 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. CONCLUSIONS: 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.
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In low-resource settings, lower-complexity tools such as partographs, Pinard stethoscopes, and intermittent handheld Doppler US have been used to track fetal well-being and labor progress.
“In low-resource settings, lower-complexity tools such as partographs, Pinard stethoscopes, and intermittent handheld Doppler US have been used to track fetal well-being and labor progress (14, 34, 35).”
From Comprehensive pregnancy monitoring with a network of wireless, soft, and flexible sensors in high- and low-resource health settings (2021) · cites this paper as [35]
There is concern that lower-complexity tools such as partographs, Pinard stethoscopes, and intermittent handheld Doppler US lack clear evidence of clinical benefit in low-resource settings.
“However, there is concern that these tools lack clear evidence of clinical benefit in low-resource settings (14, 35).”
From Comprehensive pregnancy monitoring with a network of wireless, soft, and flexible sensors in high- and low-resource health settings (2021) · cites this paper as [35]
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- Authors
- Housseine, N., Punt, M. C., Browne, J. L., Meguid, T., Klipstein-Grobusch, K., Kwast, B. E., Franx, A., Grobbee, D. E., & Rijken, M. J.
- Affiliations
- Utrecht University (NL)
- State University of Zanzibar (TZ)
- Corresponding author
- Housseine, Natasha
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-10-26
- Volume
- 13
- Issue
- 10
- Pages
- e0206295
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6203373
- OpenAlex
- W2898340147
- Cited by
- 45
- References
- 84
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 7 · 2023: 7 · 2022: 3 · 2021: 6 · 2020: 14 · 2019: 2
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Figshare (submittedVersion, cc-by)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- UMC Utrecht Global Health Support Program
- Mnazi Mmoja Hospital
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- partograph, intermittent auscultation, cardiotocography, handheld Doppler, cesarean section rate, perinatal outcomes, stillbirth, resource-limited settings, implementation barriers, admission tests
- MeSH terms
- Female, Fetal Monitoring, Humans, Income, Pregnancy, Pregnancy Outcome
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