What is the gold standard for intrapartum fetal monitoring?

Abstract

The health authorities of Stockholm county recently published a Health Technology Assessment report: "Fetal monitoring with computerized STAN analysis during labor - a systematic review" with the aim to ensure that high quality research information on costs, effectiveness and broader impact of health technologies is analysed and presented in the most efficient way for those who use, manage and work in this field. The report claims to analyse available research in relation to ST interval analysis of fetal electrocardiogram (STAN) and concludes that scientific evidence for advantages of the STAN technology for maternal and fetal outcome was insufficient and that clinical use cannot be recommended and should be restricted to research protocols. The Norwegian reference group for fetal surveillance points out that the report suffers from two insufficiencies: selection bias by not providing a complete collection of the evidence for the clinical performance of the STAN technology and, secondly, that it does not provide evidence-based alternative methods.

Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy

“…Three guidelines of unclear quality were either position statements or consensus guidelines and did not claim to be evidence based [2, 3, 54]. In five of the seven national guidelines, obstetricians or medical doctors comprised an absolute majority of the guideline development groups [40–44]. One guideline was developed by midwives only [45].…”

“…The remaining nine guidelines recommended IA, but not CTG, in low-risk women. Whereas four of the guidelines explicitly stated that admission CTG was not recommended in low-risk women [1, 39, 40, 43], the Swedish guideline recommended admission CTG for all women [42]. The remaining six guidelines did not provide any recommendation on fetal monitoring on admission.…”

“…During the first stage of labour, most guidelines recommended a frequency of every 15–30 min [1, 40–46]. Two guidelines recommended a frequency of 15-min intervals [3, 39], while one offered no recommendations regarding the frequency of auscultation [2].…”

Scientific and clinical evidence for the use of fetal ECG ST segment analysis (STAN)

“…A similar analysis by Potti and Berghella published in 2012 came to essentially the same conclusions . The Swedish Health Technology Assessment report published in 2012 included only the four randomized trials using STAN in its computerized version . They opined that “there is not enough scientific evidence to conclude that computerized ST analysis reduces the incidence of metabolic acidosis.…”

From endometriosis to perineal trauma

“…In this matter it is difficult to take all aspects into account and we do not doubt that the argument for and against ST‐analysis will continue. We have had a number of contributions on this matter in the journal, and the “gold standard” is again up for scientific debate . Even this issue has another study on this topic (Jörg Kessler and co‐workers, Bergen, Norway, pp.…”