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 so the finding must be interpreted with caution because of the small sample (n=433) of the study.

To deliver a significant number in breech presentation allowed the medical staff to become  experienced and encouraged to effective teamwork.
Thorough evaluation of intrapartum monitoring and neonatal outcome.
This study substantially larger than previous investigations on fetal monitoring in breech presentation.

– ST Analysis can be used in vaginal breech deliveries
– Acceptable neonatal outcome
– Due to the differential pattern of ST  interval changes in breech presentation a further refinement  of clinical guidelines may be needed.
– The fetal ECG pattern varies during labour in comparison with cephalic presentation.

Kessler et al 2014 BJOG

# #