ArticleBMC pregnancy and childbirth2016
Inadequate fetal heart rate monitoring and poor use of partogram associated with intrapartum stillbirth: a case-referent study in Nepal.
Article in BMC pregnancy and childbirth, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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27 citing papers in PubMed, 62 citations in OpenAlex.
- Effectiveness of a Novel Continuous Doppler (Moyo) Versus Intermittent Doppler in Intrapartum Detection of Abnormal Foetal Heart Rate: A Randomised Controlled Study in Tanzania.International journal of environmental research and public health · 2019Trial
- Involving mothers in monitoring their unborn babies during labour: experience from Liberia.BMC pregnancy and childbirth · 2026Article
- Stillbirths by maternal-obstetric characteristics and Robson classification system: a cross-sectional study from eight district hospitals in Bangladesh.Journal of global health · 2026Article
- Evaluating the implementation of intermittent versus continuous fetal heart rate monitoring on intrapartum care and early neonatal outcomes using causal mediational modeling.Frontiers in drug safety and regulation · 2026Article
- Prevalence and factors associated with stillbirth in mothers delivered by cesarean section at Orotta National Referral Maternity Hospital: case-control study.BMC pregnancy and childbirth · 2025Article
- Implementation barriers and facilitators of Moyo foetal heart rate monitor during labour in public hospitals in Nepal.Global health action · 2024Article
- Patterns of oxytocin use for induction and augmentation of labour among healthcare providers in Nigeria.BMC pregnancy and childbirth · 2024Article
- Contributing factors of birth asphyxia in Thailand: a case-control study.BMC pregnancy and childbirth · 2023Article
- Beyond research: improved perinatal care through scale-up of a Moyo fetal heart rate monitor coupled with simulation training in northern Tanzania for helping babies breathe.BMC pediatrics · 2022Article
- Factors associated with poor adherence to intrapartum fetal heart monitoring in relationship to intrapartum related death: A prospective cohort study.PLOS global public health · 2022Article
- Intrapartum Fetal Heart Monitoring Practices in Selected Facilities in Aspirational Districts of Jharkhand, Odisha and Uttarakhand.Journal of obstetrics and gynaecology of India · 2021Article
- Association between utilization and quality of antenatal care with stillbirths in four tertiary hospitals in a low-income urban setting.Acta obstetricia et gynecologica Scandinavica · 2021Article
- Consistency and timeliness of intrapartum care interventions as predictors of intrapartum stillbirth in public health facilities of Addis Ababa, Ethiopia: a case-control study.The Pan African medical journal · 2021Article
- Study on the Impact of Online Courses for Pregnant and Lying-In Women on Maternal and Infant Health during the Epidemic.Journal of healthcare engineering · 2021Article
- Disclosing suboptimal indications for emergency caesarean sections due to fetal distress and prolonged labor: a multicenter cross-sectional study at 12 public hospitals in Nepal.Reproductive health · 2020Article
- Health care professionals' adherence to partograph use in Ethiopia: analysis of 2016 national emergency obstetric and newborn care survey.BMC pregnancy and childbirth · 2020Article
- Article
- Quality of intrapartum care: direct observations in a low-resource tertiary hospital.Reproductive health · 2020Observational
- Evidence-based intrapartum practice and its associated factors at a tertiary teaching hospital in the Philippines, a descriptive mixed-methods study.BMC pregnancy and childbirth · 2020Article
- Fetal heart rate monitoring practices at a public hospital in Northern Uganda - what health workers document, do and say.Global health action · 2020Article
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Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNewborns are at the greatest risk for dying during the intrapartum period, including labor and delivery, and the first day of life. Fetal heart rate monitoring (FHRM) and partogram use to track labor progress are evidence-based techniques that can help to identify maternal and fetal risk factors so that these can be addressed early. The objective of this study was to assess health worker adherence to protocols for FHRM and partogram use during the intrapartum period, and to assess the association between adherence and intrapartum stillbirth in a tertiary hospital of Nepal.
methodsA case-referent study was conducted over a 15-month period. Cases included all intrapartum stillbirths, while 20 % of women with live births were randomly selected on admission to make up the referent population. The frequency of FHRM and the use of partogram were measured and their association to intrapartum stillbirth was assessed using logistic regression analysis.
resultsDuring the study period, 4,476 women with live births were enrolled as referents and 136 with intrapartum stillbirths as cases. FHRM every 30 min was only completed in one-fourth of the deliveries, and labor progress was monitored using a partogram in just over half. With decreasing frequency of FHRM, there was an increased risk of intrapartum stillbirth; FHRM at intervals of more than 30 min resulted in a four-fold risk increase for intrapartum stillbirth (aOR 4.17, 95 % CI 2.0-8.7), and the likelihood of intrapartum stillbirth increased seven times if FHRM was performed less than every hour or not at all (aOR 7.38, 95 % CI 3.5-15.4). Additionally, there was a three-fold increased risk of intrapartum stillbirth if the partogram was not used (aOR 3.31, 95 % CI 2.0-5.4).
conclusionThe adherence to FHRM and partogram use was inadequate for monitoring intrapartum progress in a tertiary hospital of Nepal. There was an increased risk of intrapartum stillbirth when fetal heart rate was inadequately monitored and when the progress of labor was not monitored using a partogram. Further exploration is required in order to determine and understand the barriers to adherence; and further, to develop tools, techniques and interventions to prevent intrapartum stillbirth. CLINICAL
trial registrationISRCTN97846009 .
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