Evaluating the implementation of intermittent versus continuous fetal heart rate monitoring on intrapartum care and early neonatal outcomes using causal mediational modeling

Introduction Intrapartum fetal heart rate (FHR) monitoring can detect fetal compromise and provide indications for early action. However, the effect of implementing intermittent vs. continuous FHR monitoring with Moyo remains unclear. In this study, we compare the effect of implementing intermittent vs. continuous FHR monitoring using Moyo on intrapartum care and neonatal outcomes. Methods A prospective observational design was used to evaluate two different FHR monitoring methods in seven hospitals in Nepal, with intermittent monitoring as the control group and continuous monitoring as the intervention group. The durations from 1) first Moyo placement to abnormal FHR detection and 2) first abnormal FHR detection to childbirth were compared using generalized linear regression. The causal mediational method assessed the risk of non-crying neonates after birth and intrapartum stillbirth between the groups using the Mantel–Haenszel (M–H) homogeneity method, standardizing the risk for mediators and confounders. Results A total of 1,091 participants were enrolled during the control period and 8,687 during the intervention period. Compared to the control group, the intervention group was associated with a non-significant reduction in time from first Moyo placement to abnormal FHR monitoring [adj.β = −35·5 min; 95% confidence interval (CI) = −73·2 to 2·22] and a significant reduction in time from first abnormal FHR to delivery (adj.β = −66·5 min; 95% CI = −106·2 to −26·8). The incidence of non-crying neonates was higher in the control group (11·5% vs. 10·0%), with an adjusted risk reduction of 31% (M–H RR = 0·69; 95% CI = 0·55–0·87) in the intervention group. The incidence of intrapartum stillbirth was non-significantly higher in the control group (4.5 vs. 3.0/1,000 births), with an adjusted risk reduced by 35% (M–H RR = 0·65; 95% CI = 0·25–1·70) in the intervention group. Conclusion Compared with intermittent Moyo, the duration to detect abnormal FHR and the time from abnormal FHR to delivery were significantly reduced, with a 31% reduction in the risk of neonatal resuscitation with continuous Moyo. The implementation of continuous FHR monitoring with portal devices such as Moyo can reduce the time to action following the detection of abnormal fetal heart rates and decrease the burden of infants requiring neonatal resuscitation. Clinical Trial Registration clinicaltrials.gov , identifier ISRCTN16741720.