Intermittent Auscultation (IA) of fetal heart rate
(FHR) is widely practiced across the world and its scientific validity is
important for perinatal safety. United Kingdom has led in the field of ‘IA’ and
the guidelines by National Institute for Health and Care Excellence (NICE) are
emulated world over. The NICE, the so-called ‘Intelligent Intermittent
Auscultation (IIA)’ and ‘Physiological IA’ guidelines insist that the fetal
heart sounds must be actually counted for one minute after contraction even
when using a hand-held Doppler device (ignoring the digital display) and
documented as a single number. On the other hand, a practical regime of ‘Advanced
Intermittent Auscultation (AIA)’ disbands the (mistaken) ideological commitment
to actually counting the fetal heart sounds and thereby amplifying the ability
of midwives to detect the all-important temporal variations in FHR while using
Doppler monitors. This article re-analyses an investigation disseminated by
“NHS Resolution” in 2020 following many cases of severe birth asphyxia, which
categorically assigned full accountability on the midwives for not following
the NICE guidelines. The highest level of evidence of mathematical facts in
real clinical cases proves that it was the unsafe methodology of NICE and IIA
which was primarily and largely responsible for these severe fetal hypoxemic
encephalopathies. The midwife was forced into serious errors because of the
methodology by NICE and similar regimes. The article shows how even today the
babies remain systemically exposed to serious harm and midwives to unfair blame
and distress due to unscientific NICE, IIA and similar guidelines. When pointed
out that a count over one minute gives a random average figure, not
representative of anything when there has been an acceleration or deceleration;
the IIA recommended an obsolete multiple-count method (adopted by K2MSTM)
which was practiced in 1980s before Doppler devices were available. This method
is inaccurate / suboptimal, very difficult in first stage and almost impossible
to practice in the second stage.
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