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Intrapartum fetal monitoring using fetal ECG ST segment analysis (STAN) is associated with a reduction in obstetric interventions
  1. AE Nicoll1,2,
  2. K Orr2,
  3. K Raghupathy2
  1. 1University Of Dundee, Dundee, UK
  2. 2Ninewells Hospital, Dundee, UK

Abstract

Background Intrapartum fetal monitoring with STAN has the potential to reduce maternal and neonatal morbidity and decrease obstetric interventions. Intrapartum monitoring with STAN was introduced in Ninewells Hospital, Dundee in October 2007.

Aim To assess whether increased use of STAN was associated with a reduction in fetal blood sampling (FBS). Furthermore our aims were to determine the rates of operative delivery and neonatal metabolic acidosis.

Methods Women who delivered after 37 weeks between 01 January 2007 and 31 December 2009 were included. All cardiotocograph recordings were reviewed. Information about outcomes was obtained from the local maternity database (Torex Protos Evolution, version 3.5.19).

Results Intrapartum monitoring with STAN increased from 45/188 (23.9%) in October 2007 to 105/148 (70.9%) in December 2009 (p<0.0001). The number of women that had FBS fell from 208/3020 (6.9%) in 2007, to 191/3190 (6.0%) in 2008 and 159/3141 (5.1%) in 2009 (p=0.01). The rate of operative vaginal delivery fell from 609/3020 (20.1%) in 2007, to 584/3190 (18.3%) in 2008 and 522/3141 (16.6%) in 2009 (p=0.002). The number of women that required intrapartum Caesarean section was 364/3020 (12.1%) in 2007, 404/3190 (12.7%) in 2008 and 371/3141 (11.8%) in 2009 (p=NS). The number of infants with severe neonatal metabolic acidosis was 15/3020 (0.5%) in 2007, 19/3190 (0.6%) in 2008 and 21/3141 (0.7%) in 2009 (p=NS).

Conclusion Intrapartum monitoring with STAN has increased and this has been associated with a significant reduction in FBS and operative vaginal deliveries at term. However there has been no significant change in rates of severe neonatal metabolic acidosis.

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