74: Intra partum fetal monitoring with and without ST-analysis of the fetal electrocardiogram: an analysis of missed clinical cases (preliminary results)

Article Outline

• Objective
• Study Design
• Results
• Conclusion
• Copyright

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Objective 

To descriptively evaluate cases with adverse neonatal outcome within a large randomized Dutch trial on fetal monitoring in 5667 women with a term singleton fetus in cephalic position.

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Study Design 

Fetal heart rate recordings of cases with adverse neonatal outcome were retrospectively and independently assessed by three observers. In the trial women were randomly allocated to monitoring by ST-analysis of the fetal electrocardiogram (STAN; index group) or cardiotocography (CTG) only (control group). In the present study, neonatal outcome was defined as ‘adverse′ in case of at least one of the following criteria: 1) cord-artery metabolic acidosis (pH<7.05 & BDecf>12 mmol/L); 2) cord-artery pH below 7.00; 3) perinatal death; or 4) signs of hypoxic ischemic encephalopathy.

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Results 

PRELIMINARY In total, there were 64 cases (1.1%) of adverse neonatal outcome (27 index; 37 control). In the index versus the control group, 3 (11.1%) versus 17 (45.9%) women delivered spontaneously. Observer evaluation showed that there was an indication to intervene for suspected fetal distress in 23 (92.0%) versus 24 (70.6%) cases in index versus control group. This especially concerned the second stage of labor. In the index group, indications were mainly based on a significant ST-event (52.1%) and a (pre)terminal CTG (30.4%). In the control group, half of indications were based on a (pre)terminal CTG. Clinical guidelines were violated in 7 (28.0%) and 10 (29.4%) cases of index and control group, respectively. Correct adherence to guidelines would probably have led to a better neonatal outcome in 5 of 7 versus 3 of 10 cases in the index versus the control group, respectively.

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Conclusion 

Our results imply that monitoring by STAN is more specific, regarding the aim to detect and deliver compromised fetuses, than monitoring by CTG only. Correct adherence to STAN guidelines may increase the detection rate even further.