Editors' ChoiceSTAN in clinical practice—The outcome of 2 years of regular use in the city of Gothenburg
Section snippets
Material and methods
The 2 maternity wards located at Sahlgren's University Hospitals; Oestra and Moelndal cover a population of 870,000 and were equipped with 8 STAN S 21 units from August to September 2000 after the educational process had been ongoing during the summer months. An additional 3 STAN units were used during the last 6 months of the study. These are large labor ward units, with approximately 4000 deliveries per year each and 300 members of staff. Continuous fetal monitoring (conventional EFM) is the
Results
During a 2-year period starting October 1, 2000 and finishing September 30, 2002, 14,687 deliveries entered active labor with a gestational age >36 completed weeks. Of these, 4830 (32.9%) were monitored with STAN.
Table III provides the relative distribution of indications for use of the STAN monitor based on the first 700 cases monitored at the labor ward with no previous STAN experience.
Table IV gives the characteristics of the pregnancies monitored with STAN separated into the first and
Comment
It is the aim of fetal monitoring in labor to timely identify the fetus at risk for neonatal and long-term morbidity without unnecessarily increasing the instrumental delivery rate. The development and validation of ST analysis of the fetal ECG and the STAN methodology for fetal surveillance in labor has included a long series of studies, including 2 randomized controlled trials4, 8 leading on to positive conclusions in the Cochrane library.10 However, it can always be argued that a clinical
Acknowledgments
The authors gratefully acknowledge the support from Neoventa Medical AB. The EU Commission has provided support through its Innovation grant IPS-1999-00029. The data analysis has been part of an EU supported Network of Excellence programme, BIOPATTERN.
References (14)
- et al.
Fetal heart rate monitoring: is it salvageable?
Am J Obstet Gynecol
(2000) - et al.
Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial
Lancet
(2001) - et al.
Fetal electrocardiogram in labor and neonatal outcome: data from the Swedish Randomized Controlled Trial on Intrapartum Fetal Monitoring. Fetal electrocardiography in labor and neonatal outcome: data from the Swedish randomized controlled trial on intrapartum fetal monitoring
Am J Obstet Gynecol
(2003) - et al.
Fetal ECG waveform analysis
Best Pract Res Clin Obstet Gynaecol
(2004) - et al.
Plymouth randomised trial of cardiotocogram only versus ST waveform plus cardiotocogram for intrapartum monitoring: 2,400 cases
Am J Obstet Gynaecol
(1993) Intrapartum fetal asphyxia: definition, diagnosis, and classification
Am J Obstet Gynecol
(1997)- et al.
Admission cardiotocography: a randomised controlled trial
Lancet
(2003)
Cited by (60)
Fetal electrocardiography ST-segment analysis for intrapartum monitoring: a critical appraisal of conflicting evidence and a way forward
2019, American Journal of Obstetrics and GynecologySignificant reduction in umbilical artery metabolic acidosis after implementation of intrapartum ST waveform analysis of the fetal electrocardiogram
2019, American Journal of Obstetrics and GynecologyCitation Excerpt :There was a significant reduction in the incidence of neonatal encephalopathy when comparing the years before and after the randomized trial. The continuing decrease in umbilical artery metabolic acidosis rate in the years following implementation of ST waveform analysis—with increasing use of the technique as well as increasing experience of personnel—is in line with other studies with a similar design.32,33,38,41 While these studies showed a gradual decrease in the incidence of umbilical artery metabolic acidosis over time, the incidence in our study did not decline parallel to the increasing use of ST waveform analysis.
N° 197b-Surveillance du bien-être fœtal : Directive consensus d'intrapartum
2018, Journal of Obstetrics and Gynaecology CanadaNo. 197b-Fetal Health Surveillance: Intrapartum Consensus Guideline
2018, Journal of Obstetrics and Gynaecology CanadaCombined cardiotocographic and ST event analysis: A review
2016, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :After correction of the uncovered errors and exclusion of the RCT using deviant STAN guidelines for enrollment, the latest meta-analysis showed that CTG + ST monitoring significantly reduces the need for FBS (reduction of 36%) and operative delivery (reduction of 7%), and reduces the neonatal metabolic acidosis rate (reduction of 39%) [20]. Since the introduction of STAN, several cohort studies are published [4,21–37], as summarized in Table 4. Recent observational studies investigating the effects of long-term use of ST-analysis have shown a reduction in the incidence of metabolic acidosis (base deficit in extracellular fluid (BDecf)) over time.
Effectiveness of electronic fetal monitoring with additional ST analysis in vertex singleton pregnancies at >36 weeks of gestation: An individual participant data metaanalysis
2013, American Journal of Obstetrics and GynecologyCitation Excerpt :These cases resulted in structured feedback and renewed training.25 Recent observational studies that have investigated the effects of long-term use of ST analysis have shown a decrease in the incidence of metabolic acidosisBDecf over time.25-27 Furthermore, the cases of adverse neonatal outcome that are described in the literature mainly are due to problems with the interpretation of the EFM or violation of guidelines,28,29 which further supports the hypothesis that the real impact of ST analysis is still unknown.