Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace

East CE, Smyth RMD, Leader LR, Henshall NE, Colditz PB, Tan KH

Published Online:

January 21, 2009

Vibratory and sound stimulation may help to tell how well a baby is during labour when the heart-beat is showing possible concerns.

A baby's heart rate is intermittently checked during labour to try to identify babies having difficulties. However, changes in the baby's heart-rate patterns may not always mean the baby really is having difficulties. When the heart rate pattern is not reassuring, extra tests may help to tell which babies need help. Sound and vibratory stimulation (fetal vibroacoustic stimulation) is one such test. For healthy babies it produces a positive response, and absence of this could be a sign that the baby is having difficulty. The review authors found no randomised trials that considered vibroacoustic stimulation for this use. More research would be helpful.

Abstract (click to read)

Background:

Fetal vibroacoustic stimulation is a simple, non-invasive technique where a device is placed on the maternal abdomen over the region of the fetal head and sound is emitted at a predetermined level for several seconds. It is hypothesized that the resultant startle reflex in the fetus and subsequent fetal heart rate acceleration or transient tachycardia following vibroacoustic stimulation provide reassurance of fetal well-being. This technique has been proposed as a tool to assess fetal well-being in the presence of a non-reassuring cardiotocographic trace during the first and second stages of labour.

Objectives:

To evaluate the clinical effectiveness and safety of vibroacoustic stimulation in the assessment of fetal well-being during labour, compared with mock or no stimulation for women with a singleton pregnancy exhibiting a non-reassuring fetal heart rate pattern.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 September 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2004), MEDLINE (January 1966 to January 2005), EMBASE (January 1966 to January 2005) and reference lists of all retrieved articles. We sought unpublished trials and abstracts submitted to major international congresses and contacted expert informants.

Selection criteria:

All published and unpublished randomised trials that compared maternal and fetal/neonatal/infant outcomes when vibroacoustic stimulation was used to evaluate fetal status in the presence of a non-reassuring cardiotocographic trace during labour, compared with mock or no stimulation.

Data collection and analysis:

Two independent review authors identified potential studies from the literature search and assessed them for methodological quality and appropriateness of inclusion, using a data extraction form. Attempts to contact study authors for additional information were unsuccessful.

Main results:

The search strategies yielded six studies for consideration of inclusion. However, none of these studies fulfilled the requirements for inclusion in this review.

Authors' conclusions:

There are currently no randomised controlled trials that address the safety and efficacy of vibroacoustic stimulation used to assess fetal well-being in labour in the presence of a non-reassuring cardiotocographic trace. Although vibroacoustic stimulation has been proposed as a simple, non-invasive tool for assessment of fetal well-being, there is insufficient evidence from randomised trials on which to base recommendations for use of vibroacoustic stimulation in the evaluation of fetal well-being in labour in the presence of a non-reassuring cardiotocographic trace.

This record should be cited as:

East CE, Smyth RMD, Leader LR, Henshall NE, Colditz PB, Tan KH. Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004664. DOI: 10.1002/14651858.CD004664.pub2

Assessed as up to date:

January 31, 2005

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Fetal compromise during labour > Diagnosis/prevention

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace

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