Foetal monitoring during labour: practice versus theory in a region-wide analysis

To evaluate cardiotocography (CTG) alone versus CTG and ST-analysis (STAN) in daily obstetric practice in a complete region.

Prospective registration in the region of Flanders in combination with standard registration of perinatal outcome.

Of 62,606 term deliveries registered, 57,141 (91.3%) were available for complete analysis. In 50,748 (88.8%) CTG alone and in 6,393 (11.6%) CTG+STAN was used. STAN was used significantly more in case of hypertension, diabetes and induction of labour and was associated both in univariate and multivariate analysis with significantly more secondary caesarean section for suspected foetal distress, instrumental vaginal delivery, low Apgar score and need for neonatal intensive care. There was no difference in perinatal death or asphyxia.

ST-analysis versus CTG results in more caesarean sections, instrumental vaginal deliveries and neonatal intensive care. This can not be explained solely by its use in more complicated cases as in multivariate analysis including hypertension, diabetes and induction of labour ST analysis persists as a significant factor. We hypothesise that this could be explained by less well trained users not adhering to STAN-guidelines.