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Introduction: Recent developments have produced new CTG classification systems and the question is to what extent these may affect the model of FHR + ST interpretation? The two new systems (FIGO2015 and SSOG2017) classify FHR + ST events differently from the current CTG classification system used in the STAN interpretation algorithm (STAN2007). Aim: Identify the predominant FHR patterns in connection with ST events in cases of cord artery metabolic acidosis missed by the different CTG classification systems. Indicate to what extent STAN clinical guidelines could be modified enhancing the sensitivity. Provide a pathophysiological rationale. Material and methods: Forty-four cases with umbilical cord artery metabolic acidosis were retrieved from a European multicenter database. Significant FHR + ST events were evaluated post hoc in consensus by an expert panel. Results: Eighteen cases were not identified as in need of intervention and regarded as negative in the sensitivity analysis. In 12 cases, ST changes occurred but the CTG was regarded as reassuring. Visual analysis of the FHR + ST tracings revealed specific FHR patterns: Conclusion: These findings indicate FHR + ST analysis may be undertaken regardless of CTG classification system provided there is a more physiologically oriented approach to FHR assessment in connection with an ST event. [ABSTRACT FROM AUTHOR]

Objective: Each pregravidic, gestational or intrapartum complication may, per se, have a different impact on the operative delivery rate, regardless of which fetal monitoring system was adopted. We wanted to verify if CTG plus ST interval analysis (STAN) of fetal ECG might be able to reduce the number of operative delivery for fetal distress in high-risk pregnancies compared to low-risk women monitored with CTG alone.Materials and Methods: In this cohort study, we evaluated 100 high-risk pregnancies consecutively with STAN® S31 (Neoventa Medical, Gotenburg, Sweden) and 160 low-risk pregnancies consecutively with continuous CTG (Hewlett Packard, 50 IP, Palo Alto, CA).Results: We found that STAN monitoring, although associated with a higher total operativity rate, both vaginal (11% versus 3.12%, p = 0.015) and cesarean (17% versus 4.37%, p = 0.001), reduced the cesarean section rate performed for fetal distress (29.41% versus 85.71%, p = 0.023) compared with low-risk CTG monitoring group.Conclusion: CTG plus ST interval analysis of fetal ECG reduced the risk of operative cesarean delivery for fetal distress in high-risk gestations. [ABSTRACT FROM AUTHOR]

Intrapartum cardiotocography (CTG) has a high false-positive rate. This has contributed to the rapid increase in obstetric interventions without a strong improvement in perinatal outcomes. We explore the role of ST analysis (STAN®) as an adjunct to CTG in identifying fetal asphyxia during labor. We conclude that STAN® reduces the rate of fetal blood sampling and instrumental vaginal deliveries, and has the potential to reduce the number of Australian operative interventions without compromising neonatal outcome. [ABSTRACT FROM PUBLISHER]

Objective: Maternal obesity affects one in every five women giving birth worldwide. This condition is associated with adverse perinatal outcomes, as well as increased morbidity and mortality for mother and offspring.Methods: We carried out a prospective study at the University of Pecs Medical Center, Pecs, Hungary, between 1 January 2013 and 1 January 2014. We enrolled 60 obese (body mass index >30 kg/m(2)) low-risk pregnant women and 108 age-, ethnicity-, and parity-matched nonobese pregnant control subjects. The ST segment of the fetal electrocardiogram was assessed by STAN® monitoring. Neonatal outcomes and cord gas analysis of the umbilical vessels were evaluated after birth.Results: No infant with definitive metabolic acidosis was delivered in either group. We observed 32 and 106 ST events in the obese and control group, respectively, but this difference was not statistically significant. To date, none of the infants delivered as part of this study have demonstrated developmental insufficiency.Conclusions: Obesity might not influence the fetal electrocardiogram during labor as an independent risk factor for adverse pregnancy outcomes. Studies with larger cohort sizes are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

A retrospective observational study on a sample of 13,413 deliveries analysed the effect of a withdrawal of the CTG additional diagnostic methods of fetal hypoxia (fetal pulse oximetry and ST analysis of the fetal ECG) on operative delivery rates and frequency of the umbilical arterial pH < 7.15. Following the withdrawal, obstetricians are more likely to perform caesarean sections for fetal hypoxia (OR 2.23, 95% CI 1.94-2.55, p < 0.0001 ) and labour dystocia (OR 1.45, 95% CI 1.18-1.77, p = 0.0003), which increases the overall caesarean rate (OR 1.49, 95% CI 1.38-1.61, p < 0.0001 ), although decreases the incidence of birth umbilical arterial pH < 7.15 (OR 0.43, 95% CI 0.22-0.85, p = 0.015). This also leads to the significant decline in overall frequency of instrumental vaginal deliveries (OR 0.58, 95% CI 0.48-0.71). In order to decrease the overall caesarean rate, obstetricians need to be supported by more accurate and possibly automated diagnostic tools for intrapartum fetal hypoxia. [ABSTRACT FROM AUTHOR]

Continuous intrapartum cardiotocography (CTG) augmented by fetal ECG ST segment analysis (STAN) has the potential to reduce the rates of neonatal metabolic acidosis and obstetric interventions. STAN was introduced at Ninewells Hospital, Dundee in October 2007. Data were collected prospectively from all women who received continuous intrapartum CTG and STAN between 1 October 2007 and 31 March 2008. A total of 253 women had continuous CTG and STAN. The median number of ST events was one (range = 1–32). Most (556/719, 77%) ST events were associated with a normal CTG; 46/144 (32%) patients with an ST event required immediate action. Three of the 253 (1.2%) women were delivered based on an ST event with a normal CTG; four (1.5%) had severe neonatal metabolic acidosis and all four cases had intrapartum ST events and were not managed according to STAN guidelines. ST events are common but the majority of ST events require no action. The high incidence of false-positive ST events might have contributed to the failure to act when a significant ST event occurred. [ABSTRACT FROM AUTHOR]