Belittling of a significant decline in neonatal metabolic acidosis rate achieved by STAN monitoring

Letter to the Editor accepted in AOGS regarding the latest Meta Analyses:
Belittling of a significant decline in neonatal metabolic acidosis rate achieved by STAN monitoring
Per Olofsson1,2,
DOI: 10.1111/aogs.12861
Blix et al. found in a recent meta-analysis (MA) that intrapartum fetal surveillance with ECG ST analysis (STAN) results in a significant 36% decrease in metabolic acidosis at birth compared to cardiotocography (CTG) alone (1). This demonstrates that STAN monitoring could better than CTG alone protect against hypoxia proceeding to metabolic …

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The 2015 FIGO classification of intrapartum cardiotocography: differences to the STAN classification

The STAN Clinical Guidelines classification system of cardiotocography (CTG) [1] is originally based on the FIGO classification system from 1985 [2]. In October 2015, the FIGO Intrapartum Fetal Monitoring Expert Consensus Panel presented their new CTG intrapartum classification system [3] (Table 1).
Table 1. The 2015 FIGO intrapartum cardiotocography (CTG) classification system [3] in summary.

*) Decelerations are repetitive if they occur at >50% of uterine contractions.
a) Accelerations (amplitude >15 bpm, lasting >15 s but <10 min) are …

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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
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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