Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial

Autor:	Håkan Norén, Per Olofsson, Anna-Karin Sundström, Charlotte Hellsten, Ingemar Kjellmer, Maivi Månsson, Laila Mårtensson, Andreas Herbst, Henrik Hagberg, Isis Amer-Wåhlin, Håkan Lilja, Claes Lindoff, Karel Marsal
Rok vydání:	2001
Předmět:	medicine.medical_specialty Cardiotocography Fetal Distress Umbilical Arteries law.invention Electrocardiography Randomized controlled trial Pregnancy Risk Factors law medicine Fetal distress Humans ST segment Fetal Monitoring Hypoxia Brain Sweden Chi-Square Distribution Intention-to-treat analysis medicine.diagnostic_test Cesarean Section Obstetrics business.industry Cephalic presentation Pregnancy Outcome ST Waveform Analysis General Medicine Heart Rate Fetal Hydrogen-Ion Concentration Delivery Obstetric Fetal Blood medicine.disease Female Acidosis business
Zdroj:	The Lancet. 358:534-538
ISSN:	0140-6736
DOI:	10.1016/s0140-6736(01)05703-8
Popis:	BACKGROUND: Previous studies indicate that analysis of the ST waveform of the fetal electrocardiogram provides information on the fetal response to hypoxia. We did a multicentre randomised controlled trial to test the hypothesis that intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis results in an improved perinatal outcome compared with cardiotocography alone. METHODS: At three Swedish labour wards, 4966 women with term fetuses in the cephalic presentation entered the trial during labour after a clinical decision had been made to apply a fetal scalp electrode for internal cardiotocography. They were randomly assigned monitoring with cardiotocography plus ST analysis (CTG+ST group) or cardiotocography only (CTG group). The main outcome measure was rate of umbilical-artery metabolic acidosis (pH 12 mmol/L). Secondary outcomes included operative delivery for fetal distress. Results were first analysed according to intention to treat, and secondly after exclusion of cases with severe malformations or with inadequate monitoring. FINDINGS: The CTG+ST group showed significantly lower rates of umbilical-artery metabolic acidosis than the cardiotocography group (15 of 2159 [0.7%] vs 31 of 2079 [2%], relative risk 0.47 [95% CI 0.25-0.86], p=0.02) and of operative delivery for fetal distress (193 of 2519 [8%] vs 227 of 2447 [9%], 0.83 [0.69-0.99], p=0.047) when all cases were included according to intention to treat. The differences were more pronounced after exclusion of 291 in the CTG+ST group and 283 in the CTG group with malformations or inadequate recording. INTERPRETATION: Intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis increases the ability of obstetricians to identify fetal hypoxia and to intervene more appropriately, resulting in an improved perinatal outcome.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4e1e24b02975e2f6d033b8de0d194778 https://doi.org/10.1016/s0140-6736(01)05703-8 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
Nepřihlášeným uživatelům se plný text nezobrazuje	K zobrazení výsledku je třeba se přihlásit.