Plymouth randomized trial of cardiotocogram only versus ST waveform plus cardiotocogram for intrapartum monitoring in 2400 cases

Westgate, Jenny A.; Harris, Maureen I.; Curnow, John; Greene, Kate

doi:10.1016/0002-9378(93)90273-l

Cited by 223 publications

(154 citation statements)

References 19 publications

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“…ST waveform changes have been extensively studied over the last 25 years [6]. This work has included experimental, methodological and clinical work [16], including one of the largest randomized controlled trial within the field [17].…”

Section: Discussionmentioning

confidence: 99%

“…This physiological model of interpretation has been evaluated in observational studies [1,8], and validated in a large randomised controlled trial comparing CTG ϩ ST analysis versus CTG only [17]. The Plymouth trial [17] showed a significant reduction in the number of operative interventions for suspected intrapartum asphyxia with the use of ST waveform analysis without worsening outcome and with a trend towards less incidence of metabolic acidosis in the CTG ϩ ST arm of the trial. sis During Labor" was set up (EC Trial) [15].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

European Community Multi-Center Trial “Fetal ECG Analysis During Labor”: ST plus CTG analysis

Luzietti¹,

Erkkola²,

Hasbargen³

et al. 1999

Journal of Perinatal Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

European Community Multi-Center Trial “Fetal ECG Analysis During Labor”: ST plus CTG analysis

Luzietti¹,

Erkkola²,

Hasbargen³

et al. 1999

Journal of Perinatal Medicine

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“…Patients with signal loss < 5% were included. T/QRS values ranging between 0.05 and 0.24 were regarded as normal, 0.24 and 0.5 raised and over 0.5 abnormal [9].…”

Section: Methodsmentioning

confidence: 99%

Fetal Heart Rate Monitoring Using Maternal Abdominal Surface Electrodes in Third Trimester: Can We Obtain Additional Information Other than CTG Trace?

et al. 2016

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Cardiotocography (CTG) is the most widely used method of monitoring fetal heart rate despite its low specificity for fetal acidosis and poor perinatal outcome [1]. It is derived from simple auscultation of the fetal heart, but currently Doppler ultrasound CTG is used for monitoring. Fetal electrocardiography has a greater potential for detecting impairment of fetal circulation; however, it is technically more difficult to perform than CTG.Methods of monitoring fetal well-being, both in the antepartum period and during labor, are constantly developed as they assist in identifying fetal hypoxia and reducing perinatal mortality and morbidity. From the first attempts of monitoring fetal heart rate and registering electrical activity of the fetal heart, researchers sought out a precise description of intrauterine fetal condition and an accurate assessment of the risk of fetal hypoxia. AbstractBackground. Cardiotocography (CTG) is the most widely used procedure despite its low specificity for fetal acidosis and poor perinatal outcome. Fetal electrocardiography (fECG) with transabdominal electrodes is a new, non--invasive and promising method with greater potential for detecting impairment of fetal circulation. This study is the first that attempts to assess the usefulness of fECG in comparison to CTG during antepartum period. Objectives. To determine if a single fECG examination along with CTG tracing and Doppler flow measurement in the fetal vessels has any additional clinical value in normal and intrauterine growth restricted (IUGR) fetuses. Material and Methods. The study included 93 pregnancies with IUGR, 37 pregnancies with IUGR and brain sparing effect, and 324 healthy pregnant women. The T/QRS ratio, cerebro-placental ratio (CRP), and CTG tracings were analyzed. One-way analysis of variance and Spearman's rank correlation coefficient were applied. The relationship between results of the T/QRS ratio and CTG examination among the study groups was analyzed. Results. The highest average mean value of the T/QRS ratio was recorded in the IUGR group with a normal CPR and a pathologic CTG (0.235 ± 0.014). The highest average maximum values were observed in the groups of IUGR pregnancies with a reduced CPR with normal (0.309 ± 0.100), suspicious (0.330 ± 0.102) and pathologic (0.319 ± 0.056) CTGs. Analysis of variance revealed differences between study groups regarding maximum values and the difference between maximum and minimal values of T/QRS. Correlations between groups were insignificant. Conclusions. Higher values of T/QRS ratio in IUGR pregnancies with normal and reduced CPR than in control group regardless of the result of CTG examination may indicate minimal worsening of intrauterine fetal well-being in growth retarded fetuses. No relationship between fECG examination and CTG tracings suggests that a single fECG does not provide any additional clinically significant information determining the condition of the fetus; however, further studies are required (Adv Clin Exp Med 2016, 25, 2, 309-316).

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“…Results have not been consistent across the fi ve RCTs with respect to rates of operative delivery and reduction in measures of metabolic acidemia. In some studies (UK and Swedish), the operative interventions decreased in the STAN group but not in others (Finnish, French, and Dutch) [2,49,71,75,76] . Outcomes related to metabolic acidosis were defi ned differently across the studies.…”

Section: St Segment Analysis (Stan)mentioning

confidence: 93%

New perspectives in electronic fetal surveillance

Hamilton¹,

Warrick²

2012

Journal of Perinatal Medicine

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Despite its recognized limitations, fetal heart rate monitoring is a mainstay of intrapartum care. Although the basic technology in standard electronic fetal monitors has changed little in recent decades, clinical behavior in response to heart rate monitoring has changed considerably. In addition to clearly defi ned nomenclature and clinical guidelines, there is an increased awareness that environmental and human factors can impair clinical judgment, resulting in delayed intervention and, consequently, birth-related injury. This review examines three essential steps that affect clinical outcome: (1) signal acquisition, (2) associations with physiological outcome, and (3) clinical intervention. Only the third step is directly responsible for changing clinical outcome. However, timely initiation of interventions is dependent upon the second step, which is dependent upon the fi rst step. Thus, defi ciencies at each step tend to accumulate and contribute to the worsening of overall clinical outcome. This review article summarizes advances occurring at each step. The synergy and convergence of innovations in engineering, mathematics, and behavioral science shows considerable promise in intrapartum fetal surveillance.

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Plymouth randomized trial of cardiotocogram only versus ST waveform plus cardiotocogram for intrapartum monitoring in 2400 cases

Cited by 223 publications

References 19 publications

European Community Multi-Center Trial “Fetal ECG Analysis During Labor”: ST plus CTG analysis

European Community Multi-Center Trial “Fetal ECG Analysis During Labor”: ST plus CTG analysis

Fetal Heart Rate Monitoring Using Maternal Abdominal Surface Electrodes in Third Trimester: Can We Obtain Additional Information Other than CTG Trace?

New perspectives in electronic fetal surveillance

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