INTERMITTENT FETAL HEART AUSCULTATION - CORRELATION WITH APGAR SCORE

AIM OF THE STUDY: To study the effectiveness of intermittent Fetal Heart auscultation in detecting fetal distress and its correlation with Apgar score. STUDY DESIGN: The Study includes 1000 women in labor with live fetuses between 29-40 weeks of gestation. All patients were monitored by intermittent fetal heart auscultation (IA) using a stethoscope or a hand held Doppler device. Monitoring was done every 15 min. in the 1st stage of labor and every 5min in the 2nd stage of labor. FHR was counted for at least 1 min. immediately following a contraction and the rate as well as rhythm was noted. Results of fetal monitoring were correlated with the Apgar score of the neonate. PLACE OF STUDY: The study was conducted in the department of Obstetrics and Gynecology, ESI Hospital, Sanathnagar, Hyderabad, A. P. over an 8 month period from May 2013 to December 2013 after taking permission of the ethics committee. RESULT: Out of the 1000 cases, 75 cases were detected to have fetal distress on auscultation (7.5%). At delivery, 16 patients (21.3%) of these 75 cases had an Apgar score less than 7. Out of the remaining 925 patients who had no clinical evidence of fetal distress, 6 of them (0.6%) delivered a neonate with an Apgar score less than 7. Statistical analysis of this data showed a sensitivity of intermittent auscultation in detecting fetal distress resulting in low Apgar score as 93.7% with a specificity of 74.3%. These results are similar to the published results of continuous Electronic Fetal Monitoring (EFM). CONCLUSION: Detection of fetal distress by IA is not inferior to the more invasive and expensive methods of EFM. In a country like India, where expensive monitoring gadgets are available at only a few centers, IA is an effective alternative.