Summary of findings 3. Intermittent ausculation of fetal heart rate in labour for fetal well‐being ‐ Doppler versus routine Pinard (outcomes for the baby).
| Intermittent ausculation of fetal heart rate in labour for fetal well‐being ‐ Doppler versus Routine Pinard (outcomes for the baby) | ||||||
| Patient or population: women in established labour and their babies. Setting: all studies were conducted in Africa (Zimbabwe and Uganda). Intervention: Doppler. Comparison: routine Pinard. | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with Routine Pinard | Risk with Doppler | |||||
| Apgar < 7 at 5 minutes | 20 per 1000 | 15 per 1000 (4 to 58) | RR 0.76 (0.20 to 2.87) | 2598 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1,2, 3 | One of the studies contributing data reported Apgar score < 6. |
| Cord blood acidosis | 0 per 1000 | 0 per 1000 (0 to 0) | not estimable | (0 studies) | No data reported for cord blood acidosis in the included studies. | |
| Seizures in the neonatal period | 29 per 1000 | 1 per 1000 (0 to 26) | RR 0.05 (0.00 to 0.91) | 627 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 1, 4 | Event rates are low 0/312 for Doppler and 9/315 for routine Pinard. |
| Perinatal mortality | 12 per 1000 | 8 per 1000 (1 to 63) | RR 0.69 (0.09 to 5.40) | 2597 (2 RCTs) | ⊕⊕⊝⊝ VERY LOW 1, 2, 5 | Event rates 13/1304 for Doppler and 15/1293 for routine Pinard. Neonatal deaths included, unable to separate out from reported data. |
| Composite of mortality and serious morbidity | 0 per 1000 | 0 per 1000 (0 to 0) | not estimable | (0 studies) | No data reported for a composite of mortality and serious morbidity in the included studies. | |
| Cerebral palsy | 0 per 1000 | 0 per 1000 (0 to 0) | not estimable | (0 studies) | No data reported for cerebral palsy in the included studies. | |
| Neurosensory disability | 0 per 1000 | 0 per 1000 (0 to 0) | not estimable | (0 studies) | No data reported for neurosensory disability in the included studies. | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Blinding of participants and health professionals not possible; high risk of performance bias and it is unclear if outcome assessors were blinded. Downgraded one level.
2 Evidence of imprecision with wide 95% CI crossing the line of no effect. Downgraded one level.
3 There was high heterogeneity for this outcome.
4 Evidence of imprecision, with wide 95% CI crossing the line of no effect and low event rate. Downgraded 2 levels.
5 There was high heterogeneity for this outcome. Downgraded one level.