Electrocardiogram ST Analysis During Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Gabriele Saccone1, Ewoud Schuit, Isis Amer-Wåhlin
1Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, and the Department of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Padua, Italy; the Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, California; the Medical Management Center, Department of Learning Informatics Management and Ethics and Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
Objective:
To compare the effectiveness of cardiotocography plus ST analysis with cardiotocography alone during labor.
Data Sources:
Randomized controlled trials were identified by searching electronic databases.
Methods Of Study Selection:
We included all randomized controlled trials comparing intrapartum fetal monitoring with cardiotocography plus ST analysis with cardiotocography alone. The primary outcome (ie, perinatal composite outcome) was a composite of intrapartum fetal death, neonatal death, Apgar score 3 or less at 5 minutes, neonatal seizure, metabolic acidosis (defined as umbilical arterial pH 7.05 or less, and extracellular fluid base deficit 12 mmol/L or greater), intubation for ventilation at delivery, or neonatal encephalopathy.
Tabulation, Integration, And Results:
Six randomized controlled trials, which included 26,529 laboring singletons with cephalic presentation at term, were analyzed. Compared with women who were randomized to cardiotocography, those who were randomized to ST analysis and cardiotocography had a similar incidence of perinatal composite outcome (1.5% compared with 1.6%; relative risk [RR] 0.90, 95% confidence interval [CI] 0.74-1.10; five studies), neonatal metabolic acidosis (0.5% compared with 0.7%; RR 0.74, 95% CI 0.54-1.02; five studies), admission to the neonatal intensive care unit (5.4% compared with 5.5%; RR 0.99, 95% CI 0.90-1.10; six studies), perinatal death (0.1% compared with 0.1%; RR 1.71, 95% CI 0.67-4.33; six studies), neonatal encephalopathy (0.1% compared with 0.2%; RR 0.62, 95% CI 0.25-1.52; six studies), cesarean delivery (13.8% compared with 14.0%; RR 0.96, 95% CI 0.85-1.08; six studies), and operative delivery (either cesarean or operative vaginal delivery) (23.9% compared with 25.1%; RR 0.93, 95% CI 0.86-1.01; six studies).
Conclusion:
The use of ST analysis during labor as an adjunct to the standard cardiotocography does not improve perinatal outcomes or decrease cesarean delivery.
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