Effectiveness of electronic fetal monitoring with additional ST analysis in vertex singleton pregnancies at >36 weeks of gestation

An individual participant data metaanalysis

Ewoud Schuit, Isis Amer-Wahlin, Kati Ojala, Christophe Vayssière, Michelle E M H Westerhuis, Karel Maršál, Aydin Tekay, George Saade, Gerard H A Visser, Rolf H H Groenwold, Karel G M Moons, Ben Willem J Mol, Anneke Kwee

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective: The purpose of this study was to assess the effectiveness of electronic fetal monitoring (EFM) alone and with additional ST analysis (EFM + ST) in laboring women with a singleton term pregnancy that is in cephalic presentation in the prevention of metabolic acidosis by the application of individual patient data metaanalysis. Study Design: We conducted an individual patient data metaanalysis using data from 4 randomized trials, which enabled us to account for missing data and investigate relevant subgroups. The primary outcome was metabolic acidosis, which was defined as an umbilical cord-artery pH <7.05 and a base deficit that had been calculated in the extra cellular fluid compartment >12 mmol/L. We performed 8 explanatory subgroup analyses for 8 different endpoints. Results: We analyzed data from 12,987 women and their newborn infants. Metabolic acidosis was present in 57 women (0.9%) in the EFM + ST group and 73 women (1.1%) in the EFM alone group (relative risk [RR], 0.76; 95% CI, 0.53-1.10). Compared with EFM alone, the use of EFM + ST resulted in a reduction in the frequency of instrumental vaginal deliveries (RR, 0.90; 95% CI, 0.83-0.99) and fetal blood samples (RR, 0.49; 95% CI, 0.44-0.55). Cesarean delivery rates were comparable between both groups (RR, 0.99; 95% CI, 0.91-1.09). Subgroup analyses showed that EFM + ST resulted in fewer admissions to a neonatal intensive care unit for women with a duration of pregnancy of >41 weeks (RR, 0.61; 95% CI, 0.39-0.95). Conclusion: EFM + ST does not reduce the risk of metabolic acidosis, but it does reduce the need for instrumental vaginal deliveries and fetal blood sampling.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume208
Issue number3
DOIs
StatePublished - Mar 2013

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Cardiotocography
Pregnancy
Acidosis
Fetal Blood
Umbilical Arteries
Umbilical Cord
Neonatal Intensive Care Units
Head
Newborn Infant

Keywords

  • cardiotocography
  • fetal blood sampling
  • fetal electrocardiogram
  • instrumental vaginal delivery
  • metabolic acidosis

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Effectiveness of electronic fetal monitoring with additional ST analysis in vertex singleton pregnancies at >36 weeks of gestation : An individual participant data metaanalysis. / Schuit, Ewoud; Amer-Wahlin, Isis; Ojala, Kati; Vayssière, Christophe; Westerhuis, Michelle E M H; Maršál, Karel; Tekay, Aydin; Saade, George; Visser, Gerard H A; Groenwold, Rolf H H; Moons, Karel G M; Mol, Ben Willem J; Kwee, Anneke.

In: American Journal of Obstetrics and Gynecology, Vol. 208, No. 3, 03.2013.

Research output: Contribution to journalArticle

Schuit, E, Amer-Wahlin, I, Ojala, K, Vayssière, C, Westerhuis, MEMH, Maršál, K, Tekay, A, Saade, G, Visser, GHA, Groenwold, RHH, Moons, KGM, Mol, BWJ & Kwee, A 2013, 'Effectiveness of electronic fetal monitoring with additional ST analysis in vertex singleton pregnancies at >36 weeks of gestation: An individual participant data metaanalysis', American Journal of Obstetrics and Gynecology, vol. 208, no. 3. https://doi.org/10.1016/j.ajog.2013.01.028
Schuit, Ewoud ; Amer-Wahlin, Isis ; Ojala, Kati ; Vayssière, Christophe ; Westerhuis, Michelle E M H ; Maršál, Karel ; Tekay, Aydin ; Saade, George ; Visser, Gerard H A ; Groenwold, Rolf H H ; Moons, Karel G M ; Mol, Ben Willem J ; Kwee, Anneke. / Effectiveness of electronic fetal monitoring with additional ST analysis in vertex singleton pregnancies at >36 weeks of gestation : An individual participant data metaanalysis. In: American Journal of Obstetrics and Gynecology. 2013 ; Vol. 208, No. 3.
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