Fetal scalp pH and ST analysis of the fetal ECG as an adjunct to cardiotocography to predict fetal acidosis in labor / A multi-center, case controlled study

Norén, Håkan; Luttkus, Andreas; Stupin, Jens H.; Blad, Sofia; Arulkumaran, Sabaratnam; Erkkola, Risto; Luzietti, R.; Visser, Gerard H.A.; Yli, Branka M.; Rosén, Karl G.

doi:10.1515/jpm.2007.097

Cited by 29 publications

(20 citation statements)

References 17 publications

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“…ST events coinciding with abnormal or intermediary CTG patterns were present in 67% of cases with severe and 48% of cases with moderate metabolic acidaemia (75 and 42% in cases with good signal quality). These figures are in agreement with previous reports in which CTG and ST changes preceded metabolic acidaemia (pH < 7.05 and base deficit >12) in 56–70% of cases 7,11 and acidaemia (pH < 7.05) in 77% of cases 12,13 . With good signal quality, CTG and ST abnormalities has previously been reported to precede severe and moderate metabolic acidaemia in 5/5 and 6/13 cases, resepectively, 5 and acidaemia in 89% 12,13 …”

Section: Discussionsupporting

confidence: 93%

Changes in the ST‐interval segment of the fetal electrocardiogram in relation to acid–base status at birth

Melin

Bonnevier

Cardell

et al. 2008

BJOG

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Objective To assess the occurrence of ST-interval segment changes of the fetal electrocardiogram (ECG) and cardiotocographic (CTG) abnormalities preceding acidaemia at birth.Design Case-control study.Setting University hospital labour ward.Sample Newborns with severe cord artery metabolic acidaemia (pH < 7.00 and lactate ‡ 10 mmol/l; n = 24), moderate metabolic acidaemia (pH 7.00-7.09 and lactate ‡ 10; n = 48), acidaemia (pH 7.00-7.09; n = 52), pre-acidaemia (pH 7.10-7.19; n = 265), and controls (pH ‡ 7.20; n = 117).Methods Monitoring traces were assessed blinded to outcome.Main outcome measures CTG and ST changes.Results Any ST event occurred significantly more often among cases with severe (79%) and moderate (75%) metabolic acidaemia than among controls (50%). The difference was restricted to baseline T/QRS rises and to the second stage of labour, during which any event only occurred significantly more often among cases with severe metabolic acidaemia (62%) than among controls (38%). ST events coincided with abnormal CTG patterns in 67, 44, 40, and 28% of cases with severe and moderate metabolic acidaemia, acidaemia, and pre-acidaemia, respectively, and in 12% of controls. ST events with intermediary CTG were similarly frequent in the case groups (0-6%) as in the controls (4%). The ST guidelines stated intervention in 96, 62, 73, and 49% of case groups and 23% of controls.Conclusions Only two of three cases with severe and less than half of cases with moderate metabolic acidaemia were preceded by ST events coinciding with CTG abnormalities. It is therefore important to intervene for long-lasting, rapidly deteriorating or marked (preterminal) CTG abnormalities, also in the absence of ST events.

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Section: Discussionsupporting

confidence: 93%

Changes in the ST‐interval segment of the fetal electrocardiogram in relation to acid–base status at birth

Melin

Bonnevier

Cardell

et al. 2008

BJOG

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“…These included the following types of high-risk pregnancy: women with a suspicious or abnormal external CTG, induced or oxytocin-enhanced labor, or meconium-stained amniotic fl uid. Ethical approval and informed consent were obtained at those centers where STAN monitoring was not yet part of standard care [20] .…”

Section: Methodsmentioning

confidence: 99%

How does the duration of active pushing in labor affect neonatal outcomes?

Yli

Kro

Rasmussen

et al. 2012

Journal of Perinatal Medicine

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The risks of severe acidemia, metabolic acidosis, and deteriorated neonatal outcome gradually increased with the length of TAP (>15 min), while the probability of a spontaneous vaginal delivery decreased with the duration of pushing. We suggest active physiological evaluation of the labor progress together with continuous electronic fetal monitoring during pushing irrespective of guideline thresholds.

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“…The base excess follows and the fetus develops metabolic acidosis that reduces the affinity of fetal Hb to O 2 and causes further SpO 2 reduction. The severe and prolonged decrease of O 2 supply to brain has direct correlation with brain perfusion [3].…”

Section: Terminologymentioning

confidence: 99%

Physiopathological Mechanism and Assessment of Fetal Asphyxia

Tsikouras¹,

Bothou²,

Koukouli³

et al. 2017

OJOG

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Treatment and outcome of childbirth depend on the acidobasic balance of the fetal blood related to the oxygen and carbon dioxide level. Hypoxemia could lead to asphyxia that is why fetal monitoring and biochemical parameters assessment are mandatory. Although there are compensatory mechanisms that temporarily protect the fetus, there are also other factors that interfere with the oxygenation of the fetus and determine the development of the fetus and the newborn. Actually, the level of the oxygen, the carbon dioxide, the acidobasic balance and the pH are the cornerstones of the well-being of the fetus.

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Fetal scalp pH and ST analysis of the fetal ECG as an adjunct to cardiotocography to predict fetal acidosis in labor / A multi-center, case controlled study

Abstract: ST analysis, as an adjunct to CTG, identifies adverse fetal conditions during labor similar to that of FBS but on a more consistent basis. The timing of CTG+ST changes relates to the level of acidosis at birth.

Cited by 29 publications

References 17 publications

Changes in the ST‐interval segment of the fetal electrocardiogram in relation to acid–base status at birth

Changes in the ST‐interval segment of the fetal electrocardiogram in relation to acid–base status at birth

How does the duration of active pushing in labor affect neonatal outcomes?

Physiopathological Mechanism and Assessment of Fetal Asphyxia

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