How well can the fetal heart rate baseline be assessed by intrapartum intermittent auscultation? An interrater reliability and agreement study.

BACKGROUND: We aimed to examine the inter-reliability and agreement among midwives when assessing the fetal heart rate (FHR) using the handheld Doppler. The primary aim was to measure the reliability and agreement of FHR baseline (baseline) as beats per minute (bpm). The secondary aims were to measure fluctuations from the baseline, defined as increases and decreases, and classifications (normal or abnormal) of FHR soundtracks. This is the first interrater reliability and agreement study on intermittent auscultation (IA) to our knowledge. METHODS: The participant population consisted of 154 women in labor, from a mixed-risk population and admitted to hospital for intrapartum care. The rater population were 16 midwives from various maternity care settings in Norway. A total of 154 soundtracks were recorded with a handheld Doppler device, and the 16 raters assessed 1-min soundtracks once, through an online survey (Nettskjema). They assessed the baseline, FHR increase or decrease, and the FHR classification. The primary outcome, baseline, was measured with intraclass correlation coefficient (ICC). The secondary outcomes were measured with kappa and proportion of agreement. RESULTS: The interrater reliability for the baseline (bpm) was ICC(A,1) 0.74 (95% CI 0.69-0.78). On average, an absolute difference of 7.9 bpm (95% CI 7.3-8.5 bpm) was observed between pairs of raters. CONCLUSION: Our results demonstrate an acceptable level of reliability and agreement in assessing the baseline using a handheld Doppler.

The association between waterbirth and perineal injury or other adverse outcomes among low-risk women with physiological birth: Results from the Nordic Home Birth Cohort Study.

PROBLEM/BACKGROUND: Immersion in water has known benefits, such as reducing pain and shortening the duration of labour. The relationship between waterbirth and perineal injury remains unclear. AIM: To compare the incidence of perineal injury in waterbirth and birth on land among low-risk women. Secondary outcomes were postpartum haemorrhage and 5-minute Apgar scores <7. METHODS: Prospective cohort study of 2875 low-risk women who planned a home birth in Denmark, Iceland, Norway, and Sweden in 2008-2013 and had a spontaneous vaginal birth without intervention. Descriptive statistics and logistic regression were performed. FINDINGS: A total of 942 women had a waterbirth, and 1933 gave birth on land. The groups differed in their various background variables. Multiparous women had moderately lower rates of intact perineum (59.3% vs. 63.9%) and primiparous women had lower rates of episiotomies (1.1% vs. 4.8%) in waterbirth than in birth on land. No statistically significant differences were detected in adjusted regression analysis on intact perineum in waterbirth (primiparous women's aOR = 1.03, CI 0.68-1.58; multiparous women's aOR = 0.84, CI 0.67-1.05). The rates of sphincter injuries (0.9% vs. 0.6%) were low in both groups. No significant differences were detected in secondary outcomes. DISCUSSION: The decreased incidence of intact perineum among multiparous women was modest and inconclusive, and the prevalence of sphincter injury was low. CONCLUSION: Low-risk women contemplating waterbirth should be advised to weigh the risks and benefits detected in this study against previously established benefits of waterbirth and should make an informed choice based on their values.

Intrapartum fetal monitoring practices in Norway: A population-based study.

OBJECTIVE: To describe intrapartum fetal monitoring methods used in all births in Norway in 2019-2020, assess adherence to national guidelines, investigate variation by women's risk status, and explore associations influencing monitoring practices. METHODS: A nationwide population-based study. We collected data about all pregnancies with a gestational age ≥ 22 weeks during 2019-2020 from the Medical Birth Registry of Norway. We used descriptive analyses, stratified for risk status, to examine fetal monitoring methods used in all deliveries. Univariable and multivariable logistic regression models were used to determine factors associated with monitoring with cardiotocography (CTG) in low-risk, straightforward births. RESULTS: In total, 14 285 (14%) deliveries were monitored with only intermittent auscultation (IA), 46214 (46%) with only CTG, and 33417 (34%) with IA and CTG combined. Four percent (2 067/50 533) of women with risk factors were monitored with IA only. Half (10589/21 282) of the low-risk women with straightforward births were monitored with CTG. Maternal and fetal characteristics, size of the birth unit and regional practices influenced use of CTG monitoring in this group. CONCLUSIONS: Most births are monitored with CTG only, or combined with IA. Half the women with low-risk pregnancies and straightforward births were monitored with CTG although national guidelines recommending IA.

Labor curves based on cervical dilatation over time and their accuracy and effectiveness: A systematic scoping review.

OBJECTIVES: This systematic scoping review was conducted to 1) identify and describe labor curves that illustrate cervical dilatation over time; 2) map any evidence for, as well as outcomes used to evaluate the accuracy and effectiveness of the curves; and 3) identify areas in research that require further investigation. METHODS: A three-step systematic literature search was conducted for publications up to May 2023. We searched the Medline, Maternity & Infant Care, Embase, Cochrane Library, Epistemonikos, CINAHL, Scopus, and African Index Medicus databases for studies describing labor curves, assessing their effectiveness in improving birth outcomes, or assessing their accuracy as screening or diagnostic tools. Original research articles and systematic reviews were included. We excluded studies investigating adverse birth outcomes retrospectively, and those investigating the effect of analgesia-related interventions on labor progression. Study eligibility was assessed, and data were extracted from included studies using a piloted charting form. The findings are presented according to descriptive summaries created for the included studies. RESULTS AND IMPLICATIONS FOR RESEARCH: Of 26,073 potentially eligible studies, 108 studies were included. Seventy-three studies described labor curves, of which ten of the thirteen largest were based mainly on the United States Consortium on Safe Labor cohort. Labor curve endpoints were 10 cm cervical dilatation in 69 studies and vaginal birth in 4 studies. Labor curve accuracy was assessed in 26 studies, of which all 15 published after 1986 were from low- and middle-income countries. Recent studies of labor curve accuracy in high-income countries are lacking. The effectiveness of labor curves was assessed in 13 studies, which failed to prove the superiority of any curve. Patient-reported health and well-being is an underrepresented outcome in evaluations of labor curves. The usefulness of labor curves is still a matter of debate, as studies have failed to prove their accuracy or effectiveness.