The aim of this prospective randomized study was to compare the effectiveness of pulse oximetry and ST Analysis of the fetal ECG, and to determine which method was better at identifying the labour which could continue to deliver a healthy newborn.
One hundred eighty women with a full-term, singleton, cephalic presentation and a CTG tracing with non-reassuring fetal heart rate (NRFHR) were included in the study. The rate of caesarean delivery, indication for operative delivery due to NRFHR and neonatal acid-base status was compared between the groups.
The study showed a significant difference in mode of delivery, in that the rate of caesarean section was 37% lower in the group monitored with ST Analysis. The authors conclude that both methods can prolong labour in situation with NRFHR, but that ST Analysis was more effective in safely avoiding emergency caesarean deliveries, and that this method also provided a more continuous source of information on fetal status throughout labour.
Abstract
Eur J Obstet Gynecol Reprod Biol. 2011 Oct 4. [Epub ahead of print]
Effectiveness of pulse oximetry versus fetal electrocardiography for the intrapartum evaluation of nonreassuring fetal heart rate.
Valverde M, Puertas AM, Lopez-Gallego MF, Carrillo MP, Aguilar MT, Montoya F. Obstetrics and Gynecology Service, Santa Ana Hospital, Motril, Granada, Spain.
OBJECTIVES:
To compare the effectiveness of pulse oximetry and fetal electrocardiography in the management of labor with nonreassuring fetal heart rate (NRFHR).
STUDY DESIGN:
This randomized experimental study consisted of two arms. In group 1 we used pulse oximetry and in group 2 we used STAN® technology. The participants in each group were 90 pregnant women with a full-term singleton fetus in cephalic presentation and cardiotocographic tracings compatible with NRFHR. We compared the following variables: rate of cesarean delivery, indications for operative delivery due to NRFHR, and repercussions on the newborn’s acid-base status.
RESULTS:
The two groups differed significantly in the mode of delivery, with a cesarean delivery rate of 47.6% in group 1 vs. 30% in group 2 (p=0.032). The groups did not differ in the indications for ending labor due to NRFHR (62% vs. 61%, NS). In terms of neonatal outcomes, the 1-min Apgar score was 6 or lower in 17.8% of the group 1 neonates vs. 4.44% of the group 2 neonates (p<0.001). The groups also differed significantly in umbilical cord vein pH (7.23 vs. 7.27) and pCO2 (57.27 vs. 46.86) at birth.
CONCLUSIONS:
Fetal electrocardiography with the STAN® 21 system was more effective in detecting good fetal status and thus in identifying cases in which labor could proceed safely. Intrapartum surveillance with the STAN® 21 system reduced the rate of emergency cesarean delivery.
