Routine or computerized cardiotocography in severe preeclampsia? a randomized controlled trial
To determine whether the reported saving in time required for fetal heart rate monitoring when using a computerized system of surveillance could also be achieved in patients with severe early onset preeclampsia who were managed expectantly. Methods: Patients with severe preeclampsia before 34 weeks gestation who qualified for expectant management were randomly allocated to either conventional or computerized fetal heart rate monitoring. Both groups were monitored four times daily. In the former group, monitoring was discontinued after 10 min, provided that the fetal heart rate variability was more than 5 beats/min. Recordings in the computerized group were done with the Sonicaid System 8000 and continued until the Dawes and Redman criteria were met. Results: The median time per recording was 20 min in the computerized group and 10 min in the conventionally monitored group (P < 0.0001). The Dawes and Redman criteria had not been met after 60 min in 14% of recordings in the computerized group. More deliveries were done primarily for fetal distress in the Sonicaid System 8000 group (16 versus 9, P = 0.14), but this was reversed in labor, where six patients in the conventionally monitored group developed fetal distress as compared with one in the computerized group. Conclusions: Fetal heart rate monitoring in patients with severe preeclampsia remote from term took significantly longer to perform when using the Sonicaid System 8000. However, subtle changes of fetal distress may have been missed prior to labor in the conventionally monitored group.