Effectiveness of electronic fetal monitoring with additional ST analysis in vertex singleton pregnancies at >36 weeks of gestation: an individual participant data metaanalysis

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dc.contributor.authorSchuit, E.
dc.contributor.authorAmer-Wahlin, I.
dc.contributor.authorOjala, K.
dc.contributor.authorVayssiere, C.
dc.contributor.authorWesterhuis, M.
dc.contributor.authorMarsal, K.
dc.contributor.authorTekay, A.
dc.contributor.authorSaade, G.
dc.contributor.authorVisser, G.
dc.contributor.authorGroenwold, R.
dc.contributor.authorMoons, K.
dc.contributor.authorMol, B.
dc.contributor.authorKwee, A.
dc.date.issued2013
dc.description.abstractOBJECTIVE: 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.
dc.description.statementofresponsibilityEwoud Schuit, Isis Amer-Wahlin, Kati Ojala, Christophe Vayssière, Michelle E.M.H. Westerhuis, Karel Maršál, Aydin Tekay, George R. Saade, Gerard H.A. Visser, Rolf H.H. Groenwold, Karel G.M. Moons, Ben Willem J. Mol, Anneke Kwee
dc.identifier.citationAmerican Journal of Obstetrics and Gynecology, 2013; 208(3):187.e1-187.e13
dc.identifier.doi10.1016/j.ajog.2013.01.028
dc.identifier.issn0002-9378
dc.identifier.issn1097-6868
dc.identifier.orcidMol, B. [0000-0001-6887-0262] [0000-0001-8337-550X]
dc.identifier.urihttp://hdl.handle.net/2440/88505
dc.language.isoen
dc.publisherMosby
dc.rights© 2013 Mosby, Inc. All rights reserved.
dc.source.urihttps://doi.org/10.1016/j.ajog.2013.01.028
dc.subjectCardiotocography; fetal blood sampling; fetal electrocardiogram; instrumental vaginal delivery; metabolic acidosis
dc.titleEffectiveness of electronic fetal monitoring with additional ST analysis in vertex singleton pregnancies at >36 weeks of gestation: an individual participant data metaanalysis
dc.typeJournal article
pubs.publication-statusPublished

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