A comparison of intrapartum automated fetal electrocardiography and conventional cardiotocography—a randomised controlled study

Abstract

Objective To examine whether intrapartum monitoring by means of automatic ST analysis (STAN) of fetal electrocardiography could reduce the rate of neonatal acidemia and the rate of operative intervention during labour, compared with monitoring by means of cardiotocography (CTG).Design Randomised controlled trial.Setting Labour ward in tertiary-level university hospital.Sample A total of 1483 women in active labour with singleton term fetus in cephalic presentation.Methods Women were randomly assigned to be monitored either by STAN or by CTG. Fetal blood sampling (FBS) was optional in both groups.Main outcome measures Neonatal acidemia (umbilical artery pH <7.10), neonatal metabolic acidosis (umbilical artery pH <7.05 and base excess <-12 mmol/l) and operative interventions: caesarean section rate, vacuum outlet (VO) rate and FBS rate.Results There were no statistically significant differences between the STAN group and CTG group in the incidence of neonatal acidemia (5.8 versus 4.7%) or metabolic acidosis (1.7 versus 0.7%). The caesarean section rate (6.4 versus 4.7%) and the VO rate (9.5 versus 10.7%) were also similar in the STAN and CTG groups. The incidence of FBS was lower (P < 0.001) in the STAN group (7.0%) than in the CTG group (15.6%).Conclusions Intrapartum fetal monitoring by means of automatic STAN did not improve the neonatal outcome or decrease the caesarean section rate. However, the need for FBS during labour was lower in the STAN group.

Diagnosis and Treatment of Fetal Cardiac Disease

“…334 With this technique, T-wave amplitude was noted to be increased during states of asphyxia; these changes were believed to be attributable to myocardial potassium liberation during glycolysis. 335 Results of several randomized, clinical trials using fetal electrocardiography involving >15 000 patients after 36 weeks' gestation [336][337][338] have shown variable results in the outcome measures of reduction in metabolic acidosis, decrease in moderate/severe neonatal encephalopathy, and operative delivery rate. Although the use of fetal electrocardiography may be reasonable to consider in the assessment of cardiac conduction and rhythm in fetuses with known or suspected diseases of the conduction system, its utility has not been established.…”

A Randomized Trial of Intrapartum Fetal ECG ST-Segment Analysis

“…Although our findings differ from those of two randomized trials, 8,9 they are in agreement with those of other randomized trials. [17][18][19] Our findings of no improvement in neonatal outcomes or reduction in cesarean-delivery rates are also consistent with the results of a meta-analysis of individual-patient data from ST-segment analysis trials, 20 which showed that electronic fetal monitoring with adjunctive ST-segment analysis, as compared with conventional electronic fetal monitoring alone, did not reduce the rates of neonatal metabolic acidosis, need for intubation, hypoxic-ischemic encephalopathy, a composite neonatal outcome, or cesarean delivery. 20 However, that meta-analysis showed a reduction in the frequency of fetal blood sampling (which is not routine in the United States) and operative vaginal delivery among women who underwent electronic fetal monitoring and adjunctive ST-segment analysis, as compared with those who underwent electronic fetal monitoring alone.…”

Multifractal Analysis of Fetal Heart Rate Variability in Fetuses with and without Severe Acidosis during Labor

“…1,2 Complementary methods, such as fetal scalp pH and lactates, fetal electrocardiogram (ECG) ST segment analysis, and T/QRS ratio (STAN 1 ; Neoventa Medical, Moelndal, Sweden), have been shown, at the best, to modestly reduce fetal metabolic acidosis and rate of operative deliveries. [3][4][5][6] As FHR with reduced or absent variability is one of the most significant parameters to predict the development of fetal acidosis, 2,7 some researches focused on FHR variability analysis. Objective measurement of heart rate variability can be performed with different methods like computerized analysis based on statistical description (i.e., the well-known short-and long-term variabilities), spectral analysis, entropy, and fractal approaches.…”