Comments on Blix et al. ST waveform analysis vs. cardiotocography alone

Some topics in obstetrics are more hot than others and we are in the remarkable situation that there are now more meta-analyses (MAs) than randomized controlled trials (RCTs) on the evidence for using fetal ECG ST analysis for fetal surveillance in labor. Previously six MAs (Neilson, 2012; Becker et al., 2012; Potti & Berghella, 2012; Salmelin et al., 2013; Schuit et al., 2013; Olofsson et al., 2014) on five RCTs (Westgate et al., 1993; Amer-Wåhlin et al., 2001; Ojala et …

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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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Bigger is not always better… The validity of the US randomized trial of STAN for Norway

The Norwegian reference group of fetal monitoring have made a statement regarding the US randomized trial. Please take part of their statement and recommendations!
Link to the Norwegian statement

Bigger is not always better…
The validity of the US randomized trial of STAN for Norway
Summary
The results of the US randomized trial cannot be transferred to Norwegian/European standards:
– Selection of a low-risk population (see paragraph 1)
– Other guidelines for both CTG and ST Analysis (see paragraph …

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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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The next CTG Master Class 7th-8th of December 2015

The next CTG Master Class will be held the 7th-8th of  December 2015.
The classes are conducted by the Intra Partum Fetal Monitoring group from St George´s Hospital, London University. The aim of the CTG Master Class is to give a deeper understanding of CTG and CTG interpretation.
It offers an incomparable opportunity to assess and interpret a wide range of real life obstetric emergencies. This well-respected team run courses on intrapartum CTG and fetal ECG analysis at St George´s Hospital …

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Statement regarding presentation of US randomized controlled STAN trial

On Thursday the 5th February 2015 in San Diego, California, the US randomized controlled STAN trial was presented orally at The Pregnancy Meeting of the SMFM (Society for Maternal Fetal Medicine), attended by the Neoventa US team. Full publication of this trial is expected in 2016.
During the study, over 11 000 women were randomized either to fetal monitoring with EFM (CTG) + STAN or with EFM (CTG) only. The overall result was no difference in outcome between the two …

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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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