ST Waveform Analysis versus Cardiotocography Alone for Intrapartum Fetal Monitoring: A Meta-Analysis of Randomized Trials

Potti, Sushma; Berghella, Vincenzo

doi:10.1055/s-0032-1314886

Cited by 26 publications

(18 citation statements)

References 22 publications

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“…We believe the observed variation in settings reflects expected normal variation in practice, and therefore we decided to include all six trials in our metaanalysis. We are aware that the appropriateness of including some of the trials has been discussed (8)(9)(10)(11)(12)(13)(30)(31)(32)(33) and we therefore conducted sensitivity analyses to explore the robustness of our results. The overall conclusions of this review are robust with regard to the inclusion or exclusion of the oldest study that used non-computerized ST analysis (3) and the newest that used another decision algorithm (14).…”

Section: Discussionmentioning

confidence: 99%

“…All five RCTs were performed in Europe, but they reported different outcomes and conflicting evidence. Five previous systematic reviews and one review article compared STAN with CTG alone in meta-analyses (8)(9)(10)(11)(12)(13). Three of these meta-analyses included all five RCTs (8,9,12); two (10,11) excluded the Westgate trial (3); and one (13) excluded the Vayssi ere trial (6).…”

Section: Introductionmentioning

confidence: 99%

“…Five previous systematic reviews and one review article compared STAN with CTG alone in meta-analyses (8)(9)(10)(11)(12)(13). Three of these meta-analyses included all five RCTs (8,9,12); two (10,11) excluded the Westgate trial (3); and one (13) excluded the Vayssi ere trial (6). A meta-analysis from 2012 showed no difference in perinatal outcomes between STAN and CTG alone, except for a reduction in operative vaginal deliveries (8), whereas a second meta-analysis from 2012 reported a reduction in the need for fetal blood sampling and operative vaginal deliveries (9).…”

Section: Introductionmentioning

confidence: 99%

“…Three of these meta-analyses included all five RCTs (8,9,12); two (10,11) excluded the Westgate trial (3); and one (13) excluded the Vayssi ere trial (6). A meta-analysis from 2012 showed no difference in perinatal outcomes between STAN and CTG alone, except for a reduction in operative vaginal deliveries (8), whereas a second meta-analysis from 2012 reported a reduction in the need for fetal blood sampling and operative vaginal deliveries (9). Three systematic reviews (10)(11)(12) from 2013 all reported a reduction in the need for fetal blood sampling; additionally, two found reductions in operative vaginal deliveries (11,13), and one reported a reduction in transfers to the neonatal intensive care unit (12).…”

Section: Introductionmentioning

confidence: 99%

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ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta‐analysis of randomized trials

Blix

Brurberg

Reierth

et al. 2015

Acta Obstet Gynecol Scand

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta‐analysis of randomized trials

Blix

Brurberg

Reierth

et al. 2015

Acta Obstet Gynecol Scand

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“…In the published literature, there are many studies presenting benefits from the use of computer analysis of the ST segment during labor [18,19].…”

Section: Discussionmentioning

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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Fetal monitoring and assessment

Cahill

2015

Management of Labor and Delivery

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ST Waveform Analysis versus Cardiotocography Alone for Intrapartum Fetal Monitoring: A Meta-Analysis of Randomized Trials

Abstract: There is no difference in perinatal outcomes between STAN with CTG compared with CTG alone, except for lower rate of OVD.

Cited by 26 publications

References 22 publications

ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta‐analysis of randomized trials

ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta‐analysis of randomized trials

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

Fetal monitoring and assessment

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