The number of babies born with severe oxygen deficiency, asphyxia and brain damage has decreased sharply at the university clinics in the Nordic countries that use ST Analysis, a rather new Swedish method for fetal surveillance during labour.
New statistics show a strong increase in safety at deliveries during the last few years. The new results were reported today at the 36th Nordic Congress of Obstetrics and Gynecology in Reykjavik, Iceland (NFOG).
- I Mölndal, close to Gothenburg, Sweden, the number of babies born with asphyxia have decreased by 92 percent over the last seven years.
- In the whole Gothenburg area the number of babies born with asphyxia has decreased by 80 percent during the same period.
- In Turku, Finland, only one baby has been born with asphyxia in the monitored group over the last three years.
- In Copenhagen, Denmark, the number of babies born with asphyxia has decreased by 16 percent over two years at the clinic that handles the most complicated and risky deliveries for all of Denmark.
- In Bergen, with many of Norway’s high risk deliveries, 0.8 percent of the newborns had asphyxia.
The method, ST Analysis, continuously measures how the baby is doing during labour and automatically alerts the staff if the baby becomes too weak. The analysis provides more secure data for risk assessment of the baby as well as recommendations for immediate delivery. It has also lead to fewer unnecessary caesarean deliveries.
“These are very exciting results” commented Professor Gerard Visser, Head of the Obstetrics Department at University Medical Center, Utrecht, The Netherlands. He is currently finishing a large randomised clinical trial (RCT) on ST Analysis.
“The results suggest a further improvement of outcome with prolonged experience with the ST Analysis, results also better than those obtained in the four published RCTs. This may indeed be due to the long experience with ST Analysis in these hospitals. At the time of the RCTs, many hospitals had only limited experience with ST Analysis. It is also good that improved newborn outcome is not associated with an increase in obstetric interventions. Clinics that use ST Analysis are probably also paying more attention to the fetal distress situation, which is important,” professor Visser said.
Mölndal – 92 percent fewer babies with asphyxia
Over the last seven years, the share of babies born with asphyxia has been decreased from 0.72% to 0.06% since the delivery clinic at Mölndal Hospital started using ST Analysis in 2001. At the start, the ST Analysis was used at every fourth delivery, now it is in use at 70 percent of the deliveries at the clinic.
Mölndal does not handle risk-deliveries, and for the whole Gothenburg area, including the clinic that also handles complicated deliveries, the rate of babies born with asphyxia has decreased from 0.76% to 0.15% with increasing use of ST Analysis.
The researchers have analyzed data from a total of almost 48 700 deliveries in seven years at Mölndal and Östra Hospital in Gothenburg.
During the last four years, close to 30 000 deliveries have been monitored by ST analysis in Gothenburg. This has lead to a decrease in the average perinatal death rate in Gothenburg from 6.5 to 4.3 per 100 000 deliveries since 2003. The national average for Sweden is currently 5.0-6.0.
”When you follow the guidelines for ST Analysis, STAN is a very safe method. It signals before the baby is in danger and we always respond immediately and take the baby out in 16 to 20 minutes. If you do that, there will be no babies born with asphyxia”, said Håkan Norén, Head of Obstetrics at Mölndal Hospital, where 4 000 babies will be born this year.
”We use ST Analysis on all that we continuously monitor with scalp electrode during labour. We get a very good signal and clear information from STAN. Our good numbers are also confirmed by our blood gas data.”
Turku – One single baby with asphyxia in three years
At Turku University Hospital only one baby was born with asphyxia over the last three years in the group of 2 400 deliveries that were monitored by ST Analysis.
By using ST Analysis at 17% of the hospital’s total of 25 600 deliveries, the rate of asphyxia has been decreased by more than half, from 1.5% to 0.7% since the method was introduced in 2001.
“We are using ST Analysis more and more, and are continuously getting better results. We are a very large clinic and training is very important. We hold regular meetings to discuss cases and all midwifes and doctors in training are involved.” comments Susanna Timonen, specialist in Obstetrics and Gynecology, as well as Perinatology at Turku University Hospital and responsible for ST Analysis training and methodology in Finland.
Copenhagen – More deliveries, fewer babies with asphyxia and fewer caesareans
At Rigshospitalet in Copenhagen, which handles complicated pregnancies and deliveries for all of Denmark, ST Analysis was introduced in 2004.
Despite an increase in the number of deliveries from 2005 to 2007 by almost 19%, the rate of babies with asphyxia decreased by 16%. Additionally, there was a decrease in “We have now been using STAN in our delivery ward at Rigshospitalet for more then 3 years and the results are promising. Our unit is highly specialized. Many of the patients are high-risk patients and in more then 40% of all deliveries ST Analysis is used for fetal surveillance”, said Heidi Sharif, MD and consultant at Rigshospitalet University Hospital.
“Among these high-risk women the risk of severe asphyxia is as low as 0.7%.
The implementation of STAN and our daily evaluation of STAN cases has given us a great opportunity to discuss and develop the obstetric quality in your unit, both among doctors as well as midwifes.”
Bergen – good results for high risk deliveries
An analysis from Haukeland University Hospital in Bergen, Norway, confirms the results from the other Nordic university clinics.
Haukeland has a high rate of complicated deliveries and has over three years – 2004 through 2006 – used ST Analysis at 3 236 of 14 804 deliveries (22%).
At NFOG, the clinic presented an audit of data from maternal and neonatal medical records and the Medical Birth Registry of Norway on all deliveries from week 36 with one baby where ST Analysis was used.
Of the 3 236 deliveries monitored with ST-analysis, operative delivery – caesarean, vacuum or forceps – was used in more than a third, 1 159 (37%). A total of 21 babies (0.8%) had asphyxia, as measured in umbilical cord artery sample.
”The ST Analysis indicated all cases of asphyxia”, said Jörg Kessler, consultants at the delivery clinic at Haukeland. ”We use ST Analysis exclusively at risk deliveries – when we know from the CTG or otherwise that the risk is high. We have increased the use somewhat since the start, from 25% to 30% of all deliveries.” emergency caesarean deliveries by 22% and the use of vacuum extractions by med 6%.
For further information, please contact
Dr Håkan Norén, Sweden, mobile phone +46 705685021
Dr Susanna Timonen, Finland, mobile +358 400 83 39 44
Dr Heidi Sharif, Denmark, mobile +45 26 74 30 48
Dr Jörg Kessler, Norge – mobile +47 977 096 03
Neoventa, Jan Stålemark, president, mobile +46 733 72 22 01
Neoventa communications Marianne Hjertstrand, +46 706 97 4642