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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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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Another appreciated CTG Master Class!

We are pleased to report that the CTG Master Class meeting was attended by 50 participants from Sweden, Norway and Denmark. It was the second time Sahlgrenska University Hospital, with the initiator Håkan Norén, arranged the CTG Master Class in collaboration with Neoventa Medical. The CTG Master Class was highly appreciated by obstetricians and midwives, run by the team from St George´s hospital in London with Edwin Chandraharan as a main speaker.
There is a paradigmatic shift in assessment of fetal …

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Fetal scalp blood sampling (FBS) during labour: is it a useful diagnostic test?

St George’s Healthcare NHS Trust, London, UK
Chandraharan E. Fetal scalp blood sampling during labour: is it a useful diagnostic test or a historical test that no longer has a place in modern clinical obstetrics?. BJOG 2014; DOI: 10.1111/1471-0528.12614.

 
Purchase the full paper here

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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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