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The fetal electrocardiogram: ST waveform analysis during labour

K G Rosén1, R Luzietti

  • 1Plymouth Postgraduate Medical School, University of Plymouth, Derriford Hospital, U.K.

Journal of Perinatal Medicine
|January 1, 1994
PubMed
Summary

Fetal electrocardiogram (ECG) ST waveform analysis, combined with cardiotocography (CTG), aids in interpreting intrapartum events. This combined approach, validated in a large trial, aims to reduce interventions for fetal distress without increasing risk.

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Area of Science:

  • Perinatal Medicine
  • Cardiology
  • Fetal Physiology

Background:

  • Intrapartum fetal surveillance remains debated despite extensive research.
  • Fetal electrocardiogram (ECG) ST waveform analysis is a supportive tool for interpreting cardiotocography (CTG) during labor.
  • Hypoxia triggers fetal defense mechanisms, altering myocardial oxygen balance and potentially leading to ECG waveform changes like high T waves or ST depression.

Purpose of the Study:

  • To evaluate the efficacy of combining fetal ECG ST waveform analysis with CTG for intrapartum fetal surveillance.
  • To determine if this combined approach reduces operative interventions for fetal distress compared to CTG alone.
  • To assess the safety of the combined approach in high-risk term deliveries.

Main Methods:

  • A randomized controlled trial involving 2400 high-risk, term deliveries was conducted.

Related Experiment Videos

  • The study compared intrapartum surveillance using combined ST waveform and CTG analysis versus CTG analysis alone.
  • Analysis included T/QRS ratio, ST depression, biphasic negative T waves, and correlation with cord artery pH and base deficit to assess metabolic acidemia and hypoxia duration.

    • Main Results:

    • The Plymouth trial tested the hypothesis that combined ST waveform and CTG analysis would reduce operative interventions for fetal distress.
    • The study aimed to ensure this reduction did not place the fetus at increased risk.
    • Findings suggest that significant intrapartum asphyxia risk is associated with cord artery pH below 7.0 and substantial metabolic acidemia.

    Conclusions:

    • The combination of fetal ECG ST waveform analysis and CTG provides a more accurate interpretation of intrapartum events.
    • This integrated approach has the potential to optimize fetal surveillance and reduce unnecessary interventions.
    • Further validation and adherence to clinical guidelines incorporating waveform analysis are crucial for effective intrapartum fetal monitoring.