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Author(s) -
Kent Athol,
Kirtley Shona
Publication year - 2015
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13745
Subject(s) - shona , library science , citation , audit , original research , service (business) , computer science , linguistics , accounting , business , philosophy , marketing
Fetal stress and distress are complex concepts and their diagnosis is difficult. In extreme cases where oxygenation is poor, the resultant hypoxia is evident by ‘flat’ or sinusoidal cardiotocographic (CTG) tracings and immediate action is indicated. Before metabolic disturbances become this gross, is it possible to predict deterioration from CTG tracings and would fetal ECG observations help? The rationale is that acidosis affects the myocardium leading to ECG ST segment elevation and other changes that can be picked up by software in a device linked to a fetal scalp electrode. This ST change analysis or STAN monitoring has had inconsistent reports in the literature in relation to reducing poor obstetric outcomes. Research has now been published evaluating the addition of STAN analysis to routine electronic fetal heart rate monitoring in actual obstetric practice in the USA (Belfort et al. N Engl J Med 2015;373:632–41). In a multicentre trial of over 1000 labours, the investigators made STAN analysis available as an adjunct to CTG tracings – the intervention group – or routine CTG monitoring only – the control group. The primary outcome was a set of intrapartum and neonatal adverse events including deaths, low Apgar scores, metabolic disturbances, as well as obstetric interventions and neonatal encephalopathy. The STAN intervention made no difference to the outcomes compared with standard CTG monitoring. Untoward outcomes occurred in 0.9% of the intervention group and 0.7% of the control group. Both groups had caesarean section rates around 16% and all measures of adverse events were similar. This was a pragmatic clinical trial of considerable diligence; for example 96.5% of the infants had cord blood metabolic measurements made; and yet it was unable to show any advantage in the use of more sophisticated intrapartum monitoring. It should be remembered that the membranes need to be ruptured for the scalp electrode application, an invasive procedure for the woman and her fetus, the device and its components are expensive and staff need to be trained in their use. The findings of this research clearly point away from STAN monitoring as routine practice at this stage of scientific knowledge. This result will encourage those opposing the over-medicalisation of labour and distress the device manufacturers.