The increase in detection of abnormal FHR through directly correlated to increased frequency of FHR monitoring could also be on account of the decision support algorithm in the device for raising an alarm on record of persistent abnormal FHR. Detection of abnormal FHR increased in the same period indicating the criticality of monitoring at frequent intervals. Our findings highlight that the frequency of FHR monitoring increased during the intervention. Additional data were collected from January 2020 on pregnant woman getting admitted in an advanced stage of labor and the neonatal outcome of cases detected with abnormal FHR (FHR 160 bpm). Based on 95% confidence level and plus-minus 8 confidence interval and total number of deliveries per facility level, the number of sample of case sheets reviewed was: Medical College –120, DH –100 and CHC-50. 1–2 postnatal women from each facility were also interviewed on their experience.ĭata were collected monthly on the frequency of FHR monitoring and detection of abnormal FHR. Two quarterly assessments were done by interviewing 3–4 service providers and observing 3–4 labor cases, selected purposively, per facility to assess current FHR monitoring practice and challenges. An optimum number of devices were provided to each facility based on its delivery load and number of labor tables. ![]() SBA guidelines for intermittent FHR monitoring, every half an hour in active first stage of labor and every 5 min in the second stage of labor were reiterated. The implementation started with facility-based training of service providers on FHR monitoring protocols and hands-on practice on device. Direct Observation further consolidated information on the practice of FHR monitoring in labor. Structured questionnaires were used to assess knowledge and challenges faced. Labor room register, case sheets, and partographs were reviewed for frequency of FHR monitoring and detection of abnormal FHR. Identified facilities were assessed on FHR monitoring practices using record review, provider Knowledge, and observation of skills and practices. RIMS: Rajendra Institute of Medical Sciences, DH: District Hospital, CHC: Community Health Centre, SDH: Sub Divisional Hospital The study was conducted to assess the reliability, robustness, and acceptability of the device and improve monitoring of FHR in public health settings. The CEA-certified and FDA-approved “Moyo” handheld Doppler device selected was found to address several constraints in FHR monitoring and in earlier trials had generated evidence of its reliability and utility to detect abnormal FHR. The minimalistic support premised on that an evidence-based reliable, effective, and proven technology shall require minimal handholding. The intervention was implemented at various levels of healthcare facilities with minimal support. Considering the need for improved monitoring during labor in public healthcare facilities the project, a technical support partner of Government of India, implemented a standard hand held Doppler, with key design advantages, under LaQshya (National Labour Room Quality improvement initiative) platform. ![]() However, practice of FHR monitoring is suboptimal in low resource settings where there are challenges of availability of HR, poor knowledge and inadequate resources in terms of monitoring devices. Abnormality in FHR like severe variability, bradycardia, and tachycardia during labor is associated with fetal hypoxia and adverse perinatal outcomes. Intrapartum fetal heart rate (FHR) monitoring is a global practice to assess fetal well-being during childbirth. Risk factors such as maternal infection, preterm birth and birth asphyxia contribute to early neonatal and perinatal mortality. ![]() The perinatal mortality rate in India is high at live birth.
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