Scientific and clinical evidence for the use of fetal ECG ST segment analysis (STAN)

Fetal electrocardiogram waveform analysis has been studied for many decades, but it is only in the last 20 years that computerization has made real-time analysis practical for clinical use. Changes in the ST segment have been shown to correlate with fetal condition, in particular with acid-base status. Meta-analysis of randomized trials (five in total, four using the computerized system) has shown that use of computerized ST segment analysis (STAN) reduces the need for fetal blood sampling by about 40%. However, although there are trends to lower rates of low Apgar scores and acidosis, the differences are not statistically significant. There is no effect on cesarean section rates. Disadvantages include the need for amniotic membranes to be ruptured so that a fetal scalp electrode can be applied, and the need for STAN values to be interpreted in conjunction with detailed fetal heart rate pattern analysis.