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Background Cardiotocography is almost ubiquitous in its use in intrapartum care. Although it has been demonstrated that there is some benefit from continuous intrapartum fetal monitoring using cardiotocography, there is also an increased risk of caesarean section which is accompanied by short-term and long-term risks to the mother and child. There is considerable potential to reduce unnecessary operative delivery with up to a 60% false positive diagnosis of fetal distress using cardiotocography alone. ST analysis of the fetal electrocardiogram is a promising adjunct to cardiotocography alone, and permits detection of metabolic acidosis of the fetus, potentially reducing false positive diagnosis of fetal distress. Methods This study will be a single-centre, parallel-group, randomised controlled trial, conducted over 3 years. The primary hypothesis will be that the proportion of women with an emergency caesarean section on ST analysis will not equal that for women on cardiotocography monitoring alone. Participants will be recruited at the Women’s and Children’s Hospital, a high-risk specialty facility with approximately 5000 deliveries per annum. A total of 1818 women will be randomised to the treatment or conventional arm with an allocation ratio of 1:1, stratified by parity. The primary outcome is emergency caesarean section (yes/no). Statistical analysis will follow standard methods for randomised trials and will be performed on an intention-to-treat basis. Secondary maternal and neonatal outcomes will also be analysed. Additional study outcomes include psychosocial outcomes, patient preferences and cost-effectiveness. Discussion Approximately 20% of Australian babies are delivered by emergency caesarean section. This will be the first Australian trial to examine ST analysis of the fetal electrocardiogram as an adjunct to cardiotocography as a potential method for reducing this proportion. The trial will be among the first to comprehensively examine ST analysis, taking into account the impact on psychosocial well-being as well as cost-effectiveness. This research will provide Australian evidence for clinical practice and guideline development as well as for policy-makers and consumers to make informed, evidence-based choices about care in labour. Trial registration ANZCTR, ACTRN1261800006268 . Registered on 19 January 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3640-9) contains supplementary material, which is available to authorized users.

Maternal pelvic injury resulting from road traffic accidents may cause fetal intracranial haemorrhage. A case is described. Caesarean section should be considered in acute trauma.(7Accid Emerg Med 1997;14:1 15-117) Keywords: road traffic accident; pregnancy; fetal intracranial haemorrhage.Road traffic accidents are major causes of trauma in pregnancy.' Maternal injuries include pelvic fractures, which are associated with fetal intracranial trauma.Review of published reports over the past 30 years suggests a high fetal death rate in association with fetal intracranial trauma in such circumstances.'-3 A case is presented of pelvic acetabular fracture in late pregnancy with associated fetal intracranial injury, following a road traffic accident. In the case presented, the fetus was delivered by caesarean section soon after arrival in the accident and emergency (A&E) department.This type of pelvic fracture is an uncommon injury in pregnancy, having been reported on only two previous occasions.2" The mechanism of fetal and maternal injury is discussed. On arrival the she was immediately transferred to the resuscitation area and managed according to the advanced trauma life support procedure of the American College of Surgeons. Her airway was intact, and she was able to speak (complaining of severe pain in her right hip). Her blood pressure was 150/90 and she had a pulse of 1 10 beats/min. There was no clinical evidence of abdominal, chest, or head injury, and there was no history of head injury or loss of consciousness. Cervical spine, chest x ray, and x ray of the right femur were all normal. The patient had noticed fluid draining vaginally since the accident and was now contracting 1 in 4. There was pain on any attempt at moving the right leg, particularly in the region of the right hip; the other limbs were normal. The uterine fundus was soft (between contractions), with a symphysial-fundal height consistent with 39 weeks. The fetal heart was present at a rate of 160.Radiological examination of the pelvis showed a comminuted right acetabular fracture. The fetal skull was engaged in the pelvis, with possible fractures evident over the parietal and occipital areas (fig 1).Vaginal examination revealed the cervix to be 4 cm dilated, almost fully effaced and the vertex 1 cm above the level of the ischial spines. Faintly blood stained liquor was draining. Pethidine 100 mg was given intramuscularly for analgesia (in retrospect the intravenous route may have been more appropriate). Six units of blood were cross matched; the haemoglobin on admission was 12.9 g/dl.In view of the possible fetal skull fracture it was decided to deliver the baby by emergency caesarean section. This was done under spinal anaesthesia. No uterine or other intraabdominal trauma was noted at the time of operation.A pale floppy female infant was delivered with an Apgar score of one. Initial resuscitation with oxygen by bag and mask and intramuscular naloxone produced a rapid improvement with the Apgar score of 8 at eight minutes. A large ...

BackgroundThe present study examines the introduction of an innovation in intrapartum foetal monitoring practice in Australia. ST-Analysis (STan) is a technology that adds information to conventional fetal monitoring (cardiotocography) during labour, with the aim of reducing unnecessary obstetric intervention. Adoption of this technology has been controversial amongst obstetricians and midwives, particularly as its use necessitates a more invasive means of monitoring (a scalp clip), compared to external monitoring from cardiotocography alone. If adoption of this technology is going to be successful, then understanding staff opinions about the implementation of STan in an Australian setting is an important issue for maternity care providers and policy makers.MethodsUsing a maximum variation purposive sampling method, 18 interviews were conducted with 10 midwives and 8 doctors from the Women’s and Children’s Hospital, South Australia to explore views about the introduction of the new technology. The data were analysed using Framework Analysis.ResultsMidwives and doctors indicated four important areas of consideration when introducing STan: 1) philosophy of care; 2) the implementation process including training and education; 3) the existence of research evidence; and 4) attitudes towards the new technology. Views were expressed about the management of change process, the fit of the new technology within the current models of care, the need for ongoing training and the importance of having local evidence.ConclusionsThese findings, coupled with the general literature about introducing innovation and change, can be used by other centres looking to introduce STan technology.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2920-5) contains supplementary material, which is available to authorized users.

BackgroundWomen’s views are critical for informing the planning and delivery of maternity care services. ST segment analysis (STan) is a promising method to more accurately detect when unborn babies are at risk of brain damage or death during labour that is being trialled for the first time in Australia. This is the first study to examine women’s views about STan monitoring in this context.MethodsSemi-structured interviews were conducted with pregnant women recruited across a range of clinical locations at the study hospital. The interviews included hypothetical scenarios to assess women’s prospective views about STan monitoring (as an adjunct to cardiotocography, (CTG)) compared to the existing fetal monitoring method of CTG alone. This article describes findings from an inductive and descriptive thematic analysis.ResultsMost women preferred the existing fetal monitoring method compared to STan monitoring; women’s decision-making was multifaceted. Analysis yielded four themes relating to women’s views towards fetal monitoring in labour: a) risk and labour b) mobility in labour c) autonomy and choice in labour d) trust in maternity care providers.ConclusionsFindings suggest that women’s views towards CTG and STan monitoring are multifaceted, and appear to be influenced by individual labour preferences and the information being received and understood. This underlies the importance of clear communication between maternity care providers and women about technology use in intrapartum care. This research is now being used to inform the implementation of the first properly powered Australian randomised trial comparing STan and CTG monitoring.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1598-8) contains supplementary material, which is available to authorized users.