Knowledge of fetal physiology is necessary to adequately interpret and deal with the findings on the CTG.

CTG was introduced 45 years ago as a screening tool to predict fetal hypoxia and enable obstetricians and midwives to analyse the changes of the fetal heart rate during labour to avoid intrapartum hypoxic – ischaemic injury. There has not been an improvement in the rate of cerebral palsy and perinatal deaths, however a significant increase in caesarean section and operative deliveries rate has been noted. CTG has a 60% false-positive rate and present guidelines encourage the visual interpretation of CTG based on “pattern recognition”, which has a high intra-observer variability. Knowledge of fetal physiology is necessary to adequately interpret and deal with the findings on the CTG.

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Review discussing the scientific evidence from the RCT:s and Meta-analyses, important differences in European and US trials and describes valuable information of the use of ST Analysis.

In this interesting review by Isis Amer-Wåhlin and Anneke Kwee are the scientific evidence from RCT:s and meta-analyses, all comparing CTG-only monitoring with CTG+ST Analysis, discussed and also the limitations of these studies. It also describes valuable information in certain situations of the use of ST Analysis.

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Please take part of the latest US publication regarding ST Analysis: A Randomized Trial of Intrapartum Fetal ECG ST-Segment Analysis.

In 2005, the Food and Drug Administration (FDA) approved the STAN S31 device (Neoventa Medical) for use as an adjunct to conventional electronic fetal heart-rate monitoring for fetal ECG ST Analysis.

Following the FDA approval, the largest trial that took place in regards to the STAN method was the US RCT in which over 11,000 women participated.

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Intrapartum monitoring with cardiotocography and ST wave form analysis in breech position: an observational study.

The objective of this interesting Norwegian observational study was to determine  the ECG performance  and neonatal outcome of pregnancies with breech presentation and planned vaginal delivery monitored with ST Analysis.
Main findings
The use of ST Analysis  to monitor vaginal breech deliveries is feasible and the ST changes during labour were different between breech and cephalic presentation.
The frequency of severe adverse neonatal outcome did not differ significantly between breech presentation and high risk vertex deliveries monitored by STAN, even …

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Are we (mis)guided by current guidelines on intrapartum fetal heart rate monitoring?

Case for a more physiological approach to interpretation
In this interesting paper by Austin Ugwumadu  the general characteristics of the fetal heart rate, the changes in the fetal heart rate pattern that may occur during labour are discussed.
Conclusion:
– An intact fetus with a normal CTG, who is exposed to hypoxia during labour will display a predictable set and sequence of FHR responses.
– With an abnormal CTG the clinician will be able to use the trends in fetal …

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New meta-analysis shows significant reductions in neonatal metabolic acidosis rate and in total operative delivery rate

This second part of the appraisal of RCTs comparing CTG+ST to CTG focus on the five meta-analyses (MAs) published in 2012 and 2013. As discussed in the first part, there are considerable differences in several variables in the five RCTs that make a comparison between the trials, and hence performing adequate meta-analyses, challenging. The type of meta-analyses to use, fixed- or random-effect MA, depends on the heterogeneity of the trials. A random-effect MA as a rule gives a more conservative …

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Differences in RCTs study design and size are likely to impact outcomes

This first article in a series of two, addresses the quality of the five randomized controlled trials(RCTs) comparing CTG+ST vs. CTG (Plymouth trial 1993, Swedish trial 2001, Finnish trial 2006, French trial 2007 and Dutch trial 2010). The following issues are reviewed: power calculation, pre-study training, inclusion criteria, randomization and recruitment pace, intrapartum management protocols, intrapartum interventions, cord blood and early neonatal metabolic acidosis, and neonatal outcomes.
All but the Swedish trial were underpowered for metabolic acidosis, and the majority …

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It is time to introduce ST analysis for fetal monitoring in the labor ward?

After a thorough evaluation of the published data, the authors of this commentary take a definite position in favor of ST analysis in clinical practice. The basis for their standpoint is the solid fundament of experimental data revealing the importance of changes in the ST waveform of the fetal ECG for identification of intrauterine hypoxia. In addition, it is a fact that compared to the alternative of using FBS during labor, ST analysis is less invasive (only needing one perforation …

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The ability to identify fetuses at risk of hypoxia with ST Analysis in a high risk population.

The use of ST Analysis as an adjunct to CTG has during the recent years reduced the frequency of vaginal operative deliveries, the necessity of fetal blood sampling and the number of neonates transferred to NICU.

The aim of this prospective observational study was to assess the effect of the time interval from indication of hypoxia to delivery on neonatal outcome.

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A nationwide descriptive study of obstetric claims for compensation in Norway.

“Increased training in fetal monitoring and obstetric emergency situations are recommended to decrease the obstetric compensation claims”
In this article reasons for substandard care in obstetric compensation claims are discussed.
Fetal asphyxia is the most common reason for compensation, resulting in large financial expenses to society. Human errors contribute to inadequate health care in 92 % of obstetric compensation claims, although underlying system errors may also be present.
Fetal birth asphyxia, anal sphincter tear and infection are the most common …

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