Fetal heartbeat monitoring using a stethoscope remains the best way to determine if a baby is in distress during delivery and whether caesarean section is needed, UK doctors say.

In a systematic review and network meta-analysis the researchers analysed 33 studies, including more than 118,000 patients, finding intermittent auscultation often out-performed more sophisticated monitoring techniques.

The team evaluated intermittent auscultation with either a Pinard stethoscope or a hand-held Doppler, computerised cardiotocography, cardiotocography alone, and cardiotocography with either fetal scalp lactate, fetal scalp pH analysis, fetal pulse oximetry or fetal heart ECG, as well as combinations of these.

The studies were conducted mainly in high-income countries as well as India and Tanzania.