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A complete audit cycle demonstrating that increased use of intra-partum fetal monitoring using fetal ecg st segment analysis (STAN) is associated with reduced rates of fetal blood sampling (FBS)
  1. A Y Goh,
  2. V Puli,
  3. K Ragupathy,
  4. A E Nicoll
  1. University of Dundee, Dundee, UK

Abstract

Aims To determine the frequency of intra-partum fetal monitoring with segment analysis (STAN), 2 years after its introduction to Ninewells Hospital, Dundee. Furthermore to assess whether the increased use of STAN was associated with improved obstetric outcomes.

Methods In 2007 the use of STAN was audited prospectively over 6 months. The findings were presented at local audit meetings and recommendations were made to increase the use of STAN. For the second phase of the audit, data was collected prospectively between 1 October 2009 and 31 December 2009.

Results STAN use increased from 253/1510 (17%) to 268/638 (42%) (p<0.0001). The number of women who had at least one ST event was similar (144/253 (57%) vs 149/268 (56%) (p=NS)). The number of women who had at least one attempt at fetal blood sampling (FBS) fell from 40/253 (16%) to 12/268 (4%) (p<0.0001).

Similar numbers of women required operative delivery for suspected fetal distress (47/253 (19%) vs 44/268 (16%) (p=NS)). In the first phase of the audit 3/253 (1%) were delivered because of ST events that were associated with normal cardiotocography. In the second phase no women were delivered for this reason. In both phases of the audit there were similar numbers of infants with severe metabolic acidosis (5/253 (2%) vs 4/268 (1.5%) (p=NS)).

Conclusions The rate of STAN use increased significantly and this was associated with a significant reduction in FBS. Both phases of the audit have shown that more than half of women will have at least one ST event. Completion of the audit cycle has shown a greater adherence to STAN guidelines, although this has not influenced neonatal morbidity.

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