General Obstetrics and Gynecology
Fetal electrocardiography in labor and neonatal outcome: Data from the Swedish randomized controlled trial on intrapartum fetal monitoring,☆☆

https://doi.org/10.1067/mob.2003.109Get rights and content

Abstract

Objective: Cardiotocography plus automatic ST analysis of the fetal electrocardiography has been shown recently to reduce both the operative delivery rate for fetal distress and the cord artery metabolic acidosis rate. The purpose of this study was to analyze findings that were related to cases with a complicated/adverse neonatal outcome in the Swedish randomized controlled trial. Study Design: Of the 4966 term fetuses that were included in the trial, all 351 newborn infants who required special neonatal care were identified. Cases of perinatal death, neonatal encephalopathy, or metabolic acidosis at birth were reviewed. Results: Of the 29 fetuses with adverse/complicated neonatal outcome, 22 fetuses had cardiotocography and ST patterns that indicated a need for intervention, according to the cardiotocography plus ST clinical guidelines. The number of live-born with moderate or severe neonatal encephalopathy showed a significant decrease from 0.33% (8/2447 fetuses) in the cardiotocography-only group to 0.04% (1/2519 fetuses) in the cardiotocography plus ST group. Conclusion: Cardiotocography plus ST analysis provides accurate information about intrapartum hypoxia and may prevent intrapartum asphyxia and neonatal encephalopathy by giving a clear alert to the staff members who are in charge. (Am J Obstet Gynecol 2003;188:183–92.)

Section snippets

Background study

The Swedish RCT was conducted during 18 months at three labor wards in southern Sweden.8 Women in active labor with singleton fetuses in cephalic presentation at >36 completed gestational weeks were included in the study after a decision to apply a fetal scalp electrode for continuous internal cardiotocographic recording. At power-on, the computer of the fetal heart monitor (STAN S21, Neoventa Medical, Göteborg, Sweden) randomly allocated the parturients to either monitoring with cardiotocogram

Results

One fetus died intrapartum, and 350 newborn infants (7.0% of all trial cases) were admitted to the SCBU. Of all 420 ODFD, 103 infants (24.5%) entered the SCBU. The corresponding figure for operative deliveries for failure to progress was 67 of 534 (12.5%). Of the 4012 babies who were delivered spontaneously vaginally, 180 babies (4.5 %) were admitted to the SCBU; the indications were neonatal distress (n = 8 babies), hypoglycemia (n = 14 babies), respiratory distress (n = 46 babies), clinical

Comment

The aim of intrapartum fetal monitoring is to identify fetuses for whom intervention is necessary to avoid adverse outcome. The Swedish RCT showed that combined monitoring with cardiotocogram and analysis of the ST waveform of the fetal electrocardiogram reduced the risk of fetuses being exposed to significant hypoxia that leads to metabolic acidosis at birth.8

Low et al13 have concluded that the incidence of metabolic acidosis is 2% of total births at term, with an incidence of neonatal

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Supported by European Union Innovation grant No. IPS-1999-00029, Neoventa Medical, Gothenburg and the Knowledge Foundation, Stockholm, Sweden, and by Grants to Researchers in Public Health Service from the Swedish Government.

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Reprint requests: K. G. Rosén, MD, PhD, Neoventa Medical, Lilla Bommen 1, SE 411 04 Goteborg, Sweden. E-mail: [email protected]

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