Document Type : Original Article
Authors
1
Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University
2
Professor of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University
3
Master's degree, Resident of Obstetrics and Gynecology Faculty of Medicine, Ain Shams University
4
Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University.
Abstract
Background: Monitoring the fetus during pregnancy and labor is crucial to ensure the safe delivery of a healthy baby with minimal intervention. Abnormalities in the fe-tal heart rate (FHR) often lead to adverse outcomes. The gold standard for improving fetal and neonatal outcomes is continuous FHR monitoring. In cases of fetal distress prediction, monitoring methods such as intermittent aus-cultation, cardiotocography (CTG), and other assessments are employed, with CTG becoming a routine practice in developed countries.
Objective: To investigate the accuracy of intermittent fetal monitoring in detection of fetal distress in low re-source settings.
Methods: This observational cross-sectional study was conducted at tertiary care hospital at Ain Shams Univer-sity hospitals from October 2023 till July 2024 and per-formed on total 122 pregnant women aged 18–35 years with a gestational age of 36–40 weeks. Women with ma-jor fetal anomalies, cardiac malformations, and absent fetal movements were excluded. This targeted a typical population for low-risk pregnancies, allowing the study to focus on the performance of IFM in uncomplicated cases with inclusion and exclusion criteria.
Results: There was a significant agreement between neo-natal distress and IFM distress results where the 2 mark-ers agreed in 87.7% (no distress 78.69% + distress 9.02 %) of cases. Among the group without distress, 48.6% (n=51) of deliveries were normal vaginal deliveries (NVD) and 51.4% (n=54) were cesarean sections (CS). In contrast, all deliveries in the IFM distress group were cesarean sections (100%, n=17). The Chi-square test in-dicated a significant association between MOD and IFM distress (χ²=14.19, p<0.001). The mean pH in the no distress group was 7.30±0.06, while in the IFM distress group, it was 7.11±0.13. The t-test showed a statistical-ly significant difference between the groups (t=5.725, p=0.000). Fisher's exact test was used to compare neo-natal distress and Apgar scores between groups. In the no distress group, 91.4% (n=96) of neonates had no distress, compared to 35.3% (n=6) in the IFM distress group (p<0.001). Similarly, 91.4% (n=96) of neonates in the no distress group had an Apgar score ≥7, while only 35.3% (n=6) of those in the IFM distress group achieved this score (p<0.001).
Conclusion: this study demonstrates that intermittent fetal monitoring is a practical and effective solution for managing labor in low-resource settings. It balances reliable de-tection of fetal distress with the need to min-imize unnecessary interventions, making it an essential tool for improving both maternal and neonatal outcomes. However, its mod-erate sensitivity indicates that IFM should be used alongside other clinical assessments to ensure optimal care for both mothers and their babies.
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