ST Analysis of the Fetal Electrocardiogram in Intrapartum Fetal Monitoring: A Meta-Analysis
OBJECTIVE:To compare the effects of ST-waveform analysis in combination with cardiotocography with conventional cardiotocography for intrapartum fetal monitoring. DATA SOURCES:We searched MEDLINE, Embase, and PubMed for randomized controlled trials (RCTs) evaluating ST-waveform analysis for intrapar...
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| Veröffentlicht in: | Obstetrics and gynecology (New York. 1953) 2012-01, Vol.119 (1), p.145-154 |
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| creator | Becker, Jeroen H Bax, Leon Amer-Wåhlin, Isis Ojala, Kati Vayssière, Christophe Westerhuis, Michelle E. M H Mol, Ben-Willem Visser, Gerard H A Maršál, Karel Kwee, Anneke Moons, Karel G M |
| description | OBJECTIVE:To compare the effects of ST-waveform analysis in combination with cardiotocography with conventional cardiotocography for intrapartum fetal monitoring.
DATA SOURCES:We searched MEDLINE, Embase, and PubMed for randomized controlled trials (RCTs) evaluating ST-waveform analysis for intrapartum fetal monitoring.
METHODS OF STUDY SELECTION:We identified RCTs that compared ST-waveform analysis and conventional cardiotocography for intrapartum fetal monitoring of singleton pregnancies in cephalic presentation beyond 34 weeks of gestation and evaluating at least one of the followingmetabolic acidosis, umbilical cord pH less than 7.15, umbilical cord pH less than 7.10, umbilical cord pH less than 7.05, umbilical cord pH less than 7.00, Apgar scores less than 7 at 5 minutes, admittance to the neonatal intensive care unit, need for intubation, presence of hypoxic ischemic encephalopathy, perinatal death, operative delivery, and number of fetal blood samplings.
TABULATION, INTEGRATION, AND RESULTS:Five RCTs, which included 15,352 patients, met the selection criteria. Random-effects models were used to estimate the combined relative risks (RRs) of ST analysis compared with conventional cardiotocography. Compared with conventional cardiotocography, ST analysis showed a nonsignificant reduction in metabolic acidosis (RR 0.72, 95% confidence interval 0.43–1.19, number needed to treat [NNT] 357). ST analysis significantly reduced the incidence of additional fetal blood sampling (RR 0.59, 95% confidence interval 0.44–0.79, NNT 11), operative vaginal deliveries (RR 0.88, 95% confidence interval 0.80–0.97, NNT 64), and total operative deliveries (RR 0.94, 95% confidence interval 0.89–0.99, NNT 64). For other outcomes, no differences in effect were seen between ST analysis and conventional cardiotocography, or data were not suitable for meta-analysis.
CONCLUSION:The additional use of ST analysis for intrapartum monitoring reduced the incidence of operative vaginal deliveries and the need for fetal blood sampling but did not reduce the incidence of metabolic acidosis at birth. |
| doi_str_mv | 10.1097/AOG.0b013e31823d8230 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_540039</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>918578196</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4370-a97dad3643195e70e90a92446f072e08ed887872c34a10b74ca2bacd983c79a13</originalsourceid><addsrcrecordid>eNp1kktr3DAUhU1paaZp_0Ep3pSunF49bEndDSFJAxOyaAqFLsS1LGfcyJYr2Qz599UwngQCBR30-u65gqMs-0jgjIASX9e3V2dQA2GWEUlZkwSvshWRghWUsV-vsxUAVYWQnJ9k72L8AwCkUuxtdkIpkYxSusp-_7jL1wO6x9jF3Lf5tLX5pZ3Q5RfOmil4g6Hp_H3APu-G_HqYAo4YprlfsBs_dJMP3XD_LV_nN-msOPq9z9606KL9sMyn2c_Li7vz78Xm9ur6fL0pDGcCClSiwYZVnBFVWgFWASrKedWCoBakbaQUUlDDOBKoBTdIazSNkswIhYSdZsXBN-7sONd6DF2P4VF77PRy9JBWVpccgKnEb_7Lu3lMqpP2BZI3VjHb6EpWVHOsSl3ThmvO904g0lWV7L4c7Mbg_842TrrvorHO4WD9HLUishSSqD3JD6QJPsZg26fWBPQ-VJ1C1S9DTWWflgZz3afHHIuOKSbg8wJgNOjagIPp4jNXllAqwZ_777ybbIgPbt7ZoLcW3bTV6XtARUsoKJA00q5IosD-AdpXuQQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>918578196</pqid></control><display><type>article</type><title>ST Analysis of the Fetal Electrocardiogram in Intrapartum Fetal Monitoring: A Meta-Analysis</title><source>Journals@Ovid Ovid Autoload</source><source>MEDLINE</source><creator>Becker, Jeroen H ; Bax, Leon ; Amer-Wåhlin, Isis ; Ojala, Kati ; Vayssière, Christophe ; Westerhuis, Michelle E. M H ; Mol, Ben-Willem ; Visser, Gerard H A ; Maršál, Karel ; Kwee, Anneke ; Moons, Karel G M</creator><creatorcontrib>Becker, Jeroen H ; Bax, Leon ; Amer-Wåhlin, Isis ; Ojala, Kati ; Vayssière, Christophe ; Westerhuis, Michelle E. M H ; Mol, Ben-Willem ; Visser, Gerard H A ; Maršál, Karel ; Kwee, Anneke ; Moons, Karel G M</creatorcontrib><description>OBJECTIVE:To compare the effects of ST-waveform analysis in combination with cardiotocography with conventional cardiotocography for intrapartum fetal monitoring.
DATA SOURCES:We searched MEDLINE, Embase, and PubMed for randomized controlled trials (RCTs) evaluating ST-waveform analysis for intrapartum fetal monitoring.
METHODS OF STUDY SELECTION:We identified RCTs that compared ST-waveform analysis and conventional cardiotocography for intrapartum fetal monitoring of singleton pregnancies in cephalic presentation beyond 34 weeks of gestation and evaluating at least one of the followingmetabolic acidosis, umbilical cord pH less than 7.15, umbilical cord pH less than 7.10, umbilical cord pH less than 7.05, umbilical cord pH less than 7.00, Apgar scores less than 7 at 5 minutes, admittance to the neonatal intensive care unit, need for intubation, presence of hypoxic ischemic encephalopathy, perinatal death, operative delivery, and number of fetal blood samplings.
TABULATION, INTEGRATION, AND RESULTS:Five RCTs, which included 15,352 patients, met the selection criteria. Random-effects models were used to estimate the combined relative risks (RRs) of ST analysis compared with conventional cardiotocography. Compared with conventional cardiotocography, ST analysis showed a nonsignificant reduction in metabolic acidosis (RR 0.72, 95% confidence interval 0.43–1.19, number needed to treat [NNT] 357). ST analysis significantly reduced the incidence of additional fetal blood sampling (RR 0.59, 95% confidence interval 0.44–0.79, NNT 11), operative vaginal deliveries (RR 0.88, 95% confidence interval 0.80–0.97, NNT 64), and total operative deliveries (RR 0.94, 95% confidence interval 0.89–0.99, NNT 64). For other outcomes, no differences in effect were seen between ST analysis and conventional cardiotocography, or data were not suitable for meta-analysis.
CONCLUSION:The additional use of ST analysis for intrapartum monitoring reduced the incidence of operative vaginal deliveries and the need for fetal blood sampling but did not reduce the incidence of metabolic acidosis at birth.</description><identifier>ISSN: 0029-7844</identifier><identifier>ISSN: 1873-233X</identifier><identifier>EISSN: 1873-233X</identifier><identifier>DOI: 10.1097/AOG.0b013e31823d8230</identifier><identifier>PMID: 22183222</identifier><identifier>CODEN: OBGNAS</identifier><language>eng</language><publisher>Hagerstown, MD: The American College of Obstetricians and Gynecologists</publisher><subject>Biological and medical sciences ; Cardiotocography ; Clinical Medicine ; Delivery, Obstetric - statistics & numerical data ; Delivery. Postpartum. Lactation ; Electrocardiography ; Female ; Gynecology. Andrology. Obstetrics ; Humans ; Klinisk medicin ; Medical and Health Sciences ; Medical sciences ; Medicin och hälsovetenskap ; Obstetrics, Gynecology and Reproductive Medicine ; Pregnancy ; Pregnancy Outcome ; Randomized Controlled Trials as Topic ; Reproduktionsmedicin och gynekologi</subject><ispartof>Obstetrics and gynecology (New York. 1953), 2012-01, Vol.119 (1), p.145-154</ispartof><rights>2012 The American College of Obstetricians and Gynecologists</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c4370-a97dad3643195e70e90a92446f072e08ed887872c34a10b74ca2bacd983c79a13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,4010,27900,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25505974$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22183222$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://lup.lub.lu.se/record/2273853$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:123815930$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Becker, Jeroen H</creatorcontrib><creatorcontrib>Bax, Leon</creatorcontrib><creatorcontrib>Amer-Wåhlin, Isis</creatorcontrib><creatorcontrib>Ojala, Kati</creatorcontrib><creatorcontrib>Vayssière, Christophe</creatorcontrib><creatorcontrib>Westerhuis, Michelle E. M H</creatorcontrib><creatorcontrib>Mol, Ben-Willem</creatorcontrib><creatorcontrib>Visser, Gerard H A</creatorcontrib><creatorcontrib>Maršál, Karel</creatorcontrib><creatorcontrib>Kwee, Anneke</creatorcontrib><creatorcontrib>Moons, Karel G M</creatorcontrib><title>ST Analysis of the Fetal Electrocardiogram in Intrapartum Fetal Monitoring: A Meta-Analysis</title><title>Obstetrics and gynecology (New York. 1953)</title><addtitle>Obstet Gynecol</addtitle><description>OBJECTIVE:To compare the effects of ST-waveform analysis in combination with cardiotocography with conventional cardiotocography for intrapartum fetal monitoring.
DATA SOURCES:We searched MEDLINE, Embase, and PubMed for randomized controlled trials (RCTs) evaluating ST-waveform analysis for intrapartum fetal monitoring.
METHODS OF STUDY SELECTION:We identified RCTs that compared ST-waveform analysis and conventional cardiotocography for intrapartum fetal monitoring of singleton pregnancies in cephalic presentation beyond 34 weeks of gestation and evaluating at least one of the followingmetabolic acidosis, umbilical cord pH less than 7.15, umbilical cord pH less than 7.10, umbilical cord pH less than 7.05, umbilical cord pH less than 7.00, Apgar scores less than 7 at 5 minutes, admittance to the neonatal intensive care unit, need for intubation, presence of hypoxic ischemic encephalopathy, perinatal death, operative delivery, and number of fetal blood samplings.
TABULATION, INTEGRATION, AND RESULTS:Five RCTs, which included 15,352 patients, met the selection criteria. Random-effects models were used to estimate the combined relative risks (RRs) of ST analysis compared with conventional cardiotocography. Compared with conventional cardiotocography, ST analysis showed a nonsignificant reduction in metabolic acidosis (RR 0.72, 95% confidence interval 0.43–1.19, number needed to treat [NNT] 357). ST analysis significantly reduced the incidence of additional fetal blood sampling (RR 0.59, 95% confidence interval 0.44–0.79, NNT 11), operative vaginal deliveries (RR 0.88, 95% confidence interval 0.80–0.97, NNT 64), and total operative deliveries (RR 0.94, 95% confidence interval 0.89–0.99, NNT 64). For other outcomes, no differences in effect were seen between ST analysis and conventional cardiotocography, or data were not suitable for meta-analysis.
CONCLUSION:The additional use of ST analysis for intrapartum monitoring reduced the incidence of operative vaginal deliveries and the need for fetal blood sampling but did not reduce the incidence of metabolic acidosis at birth.</description><subject>Biological and medical sciences</subject><subject>Cardiotocography</subject><subject>Clinical Medicine</subject><subject>Delivery, Obstetric - statistics & numerical data</subject><subject>Delivery. Postpartum. Lactation</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Klinisk medicin</subject><subject>Medical and Health Sciences</subject><subject>Medical sciences</subject><subject>Medicin och hälsovetenskap</subject><subject>Obstetrics, Gynecology and Reproductive Medicine</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Reproduktionsmedicin och gynekologi</subject><issn>0029-7844</issn><issn>1873-233X</issn><issn>1873-233X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kktr3DAUhU1paaZp_0Ep3pSunF49bEndDSFJAxOyaAqFLsS1LGfcyJYr2Qz599UwngQCBR30-u65gqMs-0jgjIASX9e3V2dQA2GWEUlZkwSvshWRghWUsV-vsxUAVYWQnJ9k72L8AwCkUuxtdkIpkYxSusp-_7jL1wO6x9jF3Lf5tLX5pZ3Q5RfOmil4g6Hp_H3APu-G_HqYAo4YprlfsBs_dJMP3XD_LV_nN-msOPq9z9606KL9sMyn2c_Li7vz78Xm9ur6fL0pDGcCClSiwYZVnBFVWgFWASrKedWCoBakbaQUUlDDOBKoBTdIazSNkswIhYSdZsXBN-7sONd6DF2P4VF77PRy9JBWVpccgKnEb_7Lu3lMqpP2BZI3VjHb6EpWVHOsSl3ThmvO904g0lWV7L4c7Mbg_842TrrvorHO4WD9HLUishSSqD3JD6QJPsZg26fWBPQ-VJ1C1S9DTWWflgZz3afHHIuOKSbg8wJgNOjagIPp4jNXllAqwZ_777ybbIgPbt7ZoLcW3bTV6XtARUsoKJA00q5IosD-AdpXuQQ</recordid><startdate>201201</startdate><enddate>201201</enddate><creator>Becker, Jeroen H</creator><creator>Bax, Leon</creator><creator>Amer-Wåhlin, Isis</creator><creator>Ojala, Kati</creator><creator>Vayssière, Christophe</creator><creator>Westerhuis, Michelle E. M H</creator><creator>Mol, Ben-Willem</creator><creator>Visser, Gerard H A</creator><creator>Maršál, Karel</creator><creator>Kwee, Anneke</creator><creator>Moons, Karel G M</creator><general>The American College of Obstetricians and Gynecologists</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D95</scope></search><sort><creationdate>201201</creationdate><title>ST Analysis of the Fetal Electrocardiogram in Intrapartum Fetal Monitoring: A Meta-Analysis</title><author>Becker, Jeroen H ; Bax, Leon ; Amer-Wåhlin, Isis ; Ojala, Kati ; Vayssière, Christophe ; Westerhuis, Michelle E. M H ; Mol, Ben-Willem ; Visser, Gerard H A ; Maršál, Karel ; Kwee, Anneke ; Moons, Karel G M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4370-a97dad3643195e70e90a92446f072e08ed887872c34a10b74ca2bacd983c79a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Biological and medical sciences</topic><topic>Cardiotocography</topic><topic>Clinical Medicine</topic><topic>Delivery, Obstetric - statistics & numerical data</topic><topic>Delivery. Postpartum. Lactation</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Klinisk medicin</topic><topic>Medical and Health Sciences</topic><topic>Medical sciences</topic><topic>Medicin och hälsovetenskap</topic><topic>Obstetrics, Gynecology and Reproductive Medicine</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Reproduktionsmedicin och gynekologi</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Becker, Jeroen H</creatorcontrib><creatorcontrib>Bax, Leon</creatorcontrib><creatorcontrib>Amer-Wåhlin, Isis</creatorcontrib><creatorcontrib>Ojala, Kati</creatorcontrib><creatorcontrib>Vayssière, Christophe</creatorcontrib><creatorcontrib>Westerhuis, Michelle E. M H</creatorcontrib><creatorcontrib>Mol, Ben-Willem</creatorcontrib><creatorcontrib>Visser, Gerard H A</creatorcontrib><creatorcontrib>Maršál, Karel</creatorcontrib><creatorcontrib>Kwee, Anneke</creatorcontrib><creatorcontrib>Moons, Karel G M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Lunds universitet</collection><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Becker, Jeroen H</au><au>Bax, Leon</au><au>Amer-Wåhlin, Isis</au><au>Ojala, Kati</au><au>Vayssière, Christophe</au><au>Westerhuis, Michelle E. M H</au><au>Mol, Ben-Willem</au><au>Visser, Gerard H A</au><au>Maršál, Karel</au><au>Kwee, Anneke</au><au>Moons, Karel G M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>ST Analysis of the Fetal Electrocardiogram in Intrapartum Fetal Monitoring: A Meta-Analysis</atitle><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle><addtitle>Obstet Gynecol</addtitle><date>2012-01</date><risdate>2012</risdate><volume>119</volume><issue>1</issue><spage>145</spage><epage>154</epage><pages>145-154</pages><issn>0029-7844</issn><issn>1873-233X</issn><eissn>1873-233X</eissn><coden>OBGNAS</coden><abstract>OBJECTIVE:To compare the effects of ST-waveform analysis in combination with cardiotocography with conventional cardiotocography for intrapartum fetal monitoring.
DATA SOURCES:We searched MEDLINE, Embase, and PubMed for randomized controlled trials (RCTs) evaluating ST-waveform analysis for intrapartum fetal monitoring.
METHODS OF STUDY SELECTION:We identified RCTs that compared ST-waveform analysis and conventional cardiotocography for intrapartum fetal monitoring of singleton pregnancies in cephalic presentation beyond 34 weeks of gestation and evaluating at least one of the followingmetabolic acidosis, umbilical cord pH less than 7.15, umbilical cord pH less than 7.10, umbilical cord pH less than 7.05, umbilical cord pH less than 7.00, Apgar scores less than 7 at 5 minutes, admittance to the neonatal intensive care unit, need for intubation, presence of hypoxic ischemic encephalopathy, perinatal death, operative delivery, and number of fetal blood samplings.
TABULATION, INTEGRATION, AND RESULTS:Five RCTs, which included 15,352 patients, met the selection criteria. Random-effects models were used to estimate the combined relative risks (RRs) of ST analysis compared with conventional cardiotocography. Compared with conventional cardiotocography, ST analysis showed a nonsignificant reduction in metabolic acidosis (RR 0.72, 95% confidence interval 0.43–1.19, number needed to treat [NNT] 357). ST analysis significantly reduced the incidence of additional fetal blood sampling (RR 0.59, 95% confidence interval 0.44–0.79, NNT 11), operative vaginal deliveries (RR 0.88, 95% confidence interval 0.80–0.97, NNT 64), and total operative deliveries (RR 0.94, 95% confidence interval 0.89–0.99, NNT 64). For other outcomes, no differences in effect were seen between ST analysis and conventional cardiotocography, or data were not suitable for meta-analysis.
CONCLUSION:The additional use of ST analysis for intrapartum monitoring reduced the incidence of operative vaginal deliveries and the need for fetal blood sampling but did not reduce the incidence of metabolic acidosis at birth.</abstract><cop>Hagerstown, MD</cop><pub>The American College of Obstetricians and Gynecologists</pub><pmid>22183222</pmid><doi>10.1097/AOG.0b013e31823d8230</doi><tpages>10</tpages></addata></record> |
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| identifier | ISSN: 0029-7844 |
| ispartof | Obstetrics and gynecology (New York. 1953), 2012-01, Vol.119 (1), p.145-154 |
| issn | 0029-7844 1873-233X 1873-233X |
| language | eng |
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| source | Journals@Ovid Ovid Autoload; MEDLINE |
| subjects | Biological and medical sciences Cardiotocography Clinical Medicine Delivery, Obstetric - statistics & numerical data Delivery. Postpartum. Lactation Electrocardiography Female Gynecology. Andrology. Obstetrics Humans Klinisk medicin Medical and Health Sciences Medical sciences Medicin och hälsovetenskap Obstetrics, Gynecology and Reproductive Medicine Pregnancy Pregnancy Outcome Randomized Controlled Trials as Topic Reproduktionsmedicin och gynekologi |
| title | ST Analysis of the Fetal Electrocardiogram in Intrapartum Fetal Monitoring: A Meta-Analysis |
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