Cardiotocography alone vs. cardiotocography with ST segment analysis for intrapartum fetal monitoring in women with late-term pregnancy. A randomized controlled trial

Puertas, Alberto; Góngora, Javier; Valverde, Mercedes; Revelles, Laura; Galán, Sebastián Manzanares; Carrillo, María Paz

doi:10.1016/j.ejogrb.2019.01.023

Cited by 7 publications

(15 citation statements)

References 25 publications

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“…In the present population study, we did not find that the introduction of STAN had any effect on the occurrence of intrapartum cesarean sections. This is in line with results from previous randomized controlled trials comparing CTG plus STAN with CTG alone 12–15 . However, meta‐analyses of six randomized controlled trials suggested that women randomized to fetal monitoring with STAN plus CTG had a reduced risk of instrumental vaginal delivery compared with women randomized to CTG alone 13–15 …”

Section: Discussionsupporting

confidence: 88%

“…This is in line with results from previous randomized controlled trials comparing CTG plus STAN with CTG alone. [12][13][14][15] However, meta-analyses of six randomized controlled trials suggested that women randomized to fetal monitoring with STAN plus CTG had a reduced risk of instrumental vaginal delivery compared with women randomized to CTG alone. [13][14][15] We found that the introduction of STAN increased the occurrence of Apgar score <7 at 5 min after birth.…”

Section: Discussionmentioning

confidence: 99%

“…The effect of the STAN method, compared with CTG alone, has been evaluated in seven randomized controlled trials, 6 , 7 , 8 , 9 , 10 , 11 , 12 of which six have been included in three meta‐analyses. 13 , 14 , 15 The meta‐analyses included more than 26 000 women and their neonates and concluded that STAN did not improve perinatal outcomes, such as the occurrence of Apgar score <7 at 5 min, encephalopathy, neonatal seizures, or admission to neonatal intensive care units (NICUs).…”

Section: Introductionmentioning

confidence: 99%

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The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population study

Blix

Eskild

Skau

et al. 2022

Acta Obstet Gynecol Scand

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Introduction: ST segment analysis (STAN) of the fetal electrocardiogram was introduced as an adjunct to cardiotocography for intrapartum fetal monitoring 30 years ago. We examined the impact of the introduction of STAN on changes in the occurrence of fetal and neonatal deaths, Apgar scores of <7 at 5 min, intrapartum cesarean sections, and instrumental vaginal deliveries while controlling for time-and hospitalspecific trends and maternal risk factors.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population study

Blix

Eskild

Skau

et al. 2022

Acta Obstet Gynecol Scand

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“…41,42 The median sam ple size was 894 patients (range 100-47 062). Fifteen trials (45%) [25][26][27]31,32,36,39,41,[43][44][45][46]49,51,53 included patients at 36 weeks' ges tation or more, and the remaining included patients at 26-42 weeks' gestation. [28][29][30][33][34][35]38,40,50,52,54,56 Twothirds of trials ( 7 3 % ) i n c l u d e d p a t i e n t s w i t h h i g h r i s k p r e g n a n cies, [25][26][27][28][29][30][31][32][33][34]36,38,39,41,44,47,48,50,51,53,54 3 (9%) included patients with low risk ...…”

Section: Resultsmentioning

confidence: 99%

“…40,42,43,52 Three studies did not report on pregnancy risks. 45,46,49 The inclusion and exclusion criteria of each trial are summarized in Appendix 1, Supplementary Table 1.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes: a systematic review and network meta-analysis

Wattar

Honess

Bunnewell

et al. 2021

CMAJ

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BACKGROUND: Cesarean delivery is the most common surgical procedure worldwide. Intrapartum fetal surveil lance is routinely offered to improve neonatal outcomes, but the effects of different methods on the risk of emergency cesarean deliveries remains uncertain. We conducted a systematic review and network metaanalysis to evaluate the effectiveness of different types of fetal surveillance. METHODS:We searched MEDLINE, Embase and CENTRAL until June 1, 2020, for randomized trials evaluating any intrapartum fetal surveillance method. We performed a network metaanalysis within a frequentist framework. We assessed the quality and network incon sistency of trials. We reported primarily INTERPRETATION: Compared with other types of fetal surveillance, intermittent auscultation seems to reduce emer gency cesarean deliveries in labour without increasing adverse neonatal and maternal outcomes.

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Comparison of effect of CTG + STan with CTG alone on emergency Cesarean section rate: STan Australian Randomized controlled Trial (START)

Kuah

Simpson

Salter

et al. 2023

Ultrasound in Obstet & Gyne

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ObjectiveTo reduce emergency Cesarean section (EmCS) rates by using ST analysis of the fetal electrocardiogram (STan) as an adjunct to continuous cardiotocography (CTG).MethodsA randomized, controlled trial enrolled patients with a singleton fetus in cephalic presentation, greater than or equal to 36 weeks gestation, requiring continuous electronic fetal monitoring in labor at a tertiary maternity hospital in Adelaide, Australia, between January 2018 and July 2021. Participants were randomized to receive CTG+STan or CTG alone. Calculated sample size was 1818 participants. The primary outcome was EmCS. Secondary outcomes included metabolic acidosis, a composite perinatal outcome, and other maternal and neonatal morbidity and safety outcomes.ResultsThe present study enrolled 970 women. The primary outcome of EmCS occurred in 107/482 (22.2%) of the CTG+STan arm and in 107/485 (22.1%) in the CTG alone arm (adjusted relative risk (RR), 1.02 (95% CI, 0.81–1.27), P=0.89).ConclusionsThe addition of STan as an adjunct to continuous CTG did not reduce the EmCS rate. The smaller than anticipated sample size for this study meant that it was underpowered to detect absolute differences less than or equal to 5% and therefore this finding is possibly due to a Type 2 error, where a difference may exist but the study was underpowered to detect it.This article is protected by copyright. All rights reserved.

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Cardiotocography alone vs. cardiotocography with ST segment analysis for intrapartum fetal monitoring in women with late-term pregnancy. A randomized controlled trial

Cited by 7 publications

References 25 publications

The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population study

The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population study

Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes: a systematic review and network meta-analysis

Comparison of effect of CTG + STan with CTG alone on emergency Cesarean section rate: STan Australian Randomized controlled Trial (START)

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