Steve April 6, 2021

April 6 (UPI) — Basic fetal heartbeat monitoring is still the best method for determining whether a baby is in distress and Caesarean delivery is needed, according to an analysis published Monday by the Canadian Medical Association Journal.

The approach, which was been used for more than 50 years, reduced the use of emergency C-section by an average 30% compared to other methods, such as echocardiograms and blood tests, the data showed.

The findings suggest that fetal heartbeat monitoring, called intermittent auscultation, with a stethoscope — which is easier, less invasive and less costly than these newer approaches — remains the most effective, the researchers said.

“Despite extensive investment in clinical research, the overall effectiveness of [newer] methods in improving maternal and neonatal outcomes remains debatable,” wrote the researchers from the University of Warwick Medical School in Coventry, England.

This is evidenced by the fact that “stillbirth rates have plateaued worldwide, while Caesarean delivery rates continue to rise,” they said.

Rates of stillbirth in the United States have declined by about 33% since 1990, though they have remained stable since the mid-2000s, according to the Centers for Disease Control and Prevention.

Each year, approximately 24,000 stillbirths are reported annually in the United States, for a rate of about three 100,000 births, and nearly one in three deliveries nationally are performed via C-section, the agency estimates.

Worldwide, Caesarean delivery is the most common surgical procedure, and it is performed to expedite birth and avoid neonatal complications, the University of Warwick researchers said.

For their analysis, the researchers reviewed data from 33 studies that included more than 118,000 women to evaluate the effectiveness of different fetal monitoring methods in improving outcomes for mothers and babies and reducing the number of Caesarean deliveries.

They compared listening to the fetal heart rate using a stethoscope, which has long been used to assess fetal health and whether the baby is experiencing distress that might necessitate a Caesarean delivery, with newer techniques such as fetal echocardiograms and blood tests.

An echocardiogram is an imaging technology, similar to an ultrasound, that measures heart rate and movement, according to the Cleveland Clinic.

All of the fetal monitoring methods used in the 33 studies produced similar outcomes for babies, in terms of health and survival at birth, but only heartbeat monitoring reduced the risk of Caesarean deliveries without increased risk to babies’ health.

“Our analysis suggests that all additional methods introduced to improve the accuracy of electronic fetal heart monitoring have failed to reduce the risk of adverse neonatal or maternal outcomes,” the researchers wrote.

“This may have contributed to the increased incidence of unnecessary emergency Caesarean deliveries,” they said.

The authors urge investment in developing novel techniques to monitor fetuses to make delivery safer for mothers and their babies.

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