Telephone Fetal Heart Rate Monitoring in South Australia

EDITORIAL COMMENT : We accepted this paper for publication to remind readers again (A) that fetal cardiotocographs can be transmitted, over the telephone for interpretation by an expert. As the authors say this paper is not intended to argue the merits of cardiotocography or its indications. However we wish to comment on the authors' statement that gestational diabetes and hypertension are questionable indications for cardiotocography. These 2 conditions are classically associated with intrauterine death and in the case of gestational diabetes there may be no clinical warning such as the presence of fetal growth retardation, deaths in this condition being precisely similar to those that occur in women with insulin‐dependant prepregnancy diabetes mellitus (B). These are the very conditions in which cardiotocography may show the features of impending fetal death and hence indicate immediate delivery. A. Moore KH, Sill R. Domiciliary fetal monitoring in a district maternity unit. Aust NZ J Obstet Gynaecol 1990; 30: 36–40. B. White BM, Beischer NA. Perinatal mortality in the infants of diabetic women. Aust NZ J Obstet Gynaecol 1990; 30: 323–326. Summary: A pilot trial was conducted to assess the technical feasibility of long range fetal heart monitoring by telephone in an Australian setting. The indications for such monitoring and patient ability and attitude towards self‐monitoring was also assessed. One hundred and fifty seven tracings were received from 57 women using a simple doppler device to transmit fetal heart sounds to the central hospital fetal monitor. Thirty three of the patients were in country hospitals and 24 were at home. Gestation ranged from 26 to 42 weeks' gestation. Eighty six percent of the country hospital tracings and 94% of the home tracings were easily interpretable. The large majority of tracings were normal and appeared to encourage conservative management by the attendants. Two tracings were abnormal and these influenced early delivery in both cases. Nearly all women using the monitor at home found the procedure easy and reassuring. Tracings from country hospitals were initiated usually after an acute antenatal complication, whereas the indications for home‐monitoring were prompted by longer‐term, medium‐risk factors. Home‐monitoring may reduce the inconvenience and expense of inpatient or outpatient care and country hospitals without electronic fetal monitors may benefit from such a service. The selection of patients who might benefit from such technology remains controversial and warrants a prospective randomized controlled trial.