ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta‐analysis of randomized trials
Abstract Introduction ST waveform analysis (STAN) was introduced as an adjunct to cardiotocography (CTG) to improve neonatal and maternal outcomes. The aim of the present study was to quantify the efficacy of STAN vs CTG and assess the quality of the evidence using GRADE. Material and methods We per...
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Wiley
2024-03-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14752 |
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| author | Ellen Blix Kjetil Gundro Brurberg Eirik Reierth Liv Merete Reinar Pål Øian |
| author_facet | Ellen Blix Kjetil Gundro Brurberg Eirik Reierth Liv Merete Reinar Pål Øian |
| author_sort | Ellen Blix |
| collection | DOAJ |
| description | Abstract Introduction ST waveform analysis (STAN) was introduced as an adjunct to cardiotocography (CTG) to improve neonatal and maternal outcomes. The aim of the present study was to quantify the efficacy of STAN vs CTG and assess the quality of the evidence using GRADE. Material and methods We performed systematic literature searches to identify randomized controlled trials and assessed included studies for risk of bias. We performed meta‐analyses, calculating pooled risk ratio (RR) or Peto odds ratio (OR). We also performed post hoc trial sequential analyses for selected outcomes to assess the risk of false‐positive results and the need for additional studies. Results Nine randomized controlled trials including 28 729 women were included in the meta‐analysis. There were no differences between the groups in operative deliveries for fetal distress (10.9 vs 11.1%; RR 0.96; 95% confidence interval [CI] 0.82–1.11). STAN was associated with a significantly lower rate of metabolic acidosis (0.45% vs 0.68%; Peto OR 0.66; 95% CI 0.48–0.90). Accordingly, 441 women need to be monitored with STAN instead of CTG alone to prevent one case of metabolic acidosis. Women allocated to STAN had a reduced risk of fetal blood sampling compared with women allocated to conventional CTG monitoring (12.5% vs 19.6%; RR 0.62; 95% CI 0.49–0.80). The quality of the evidence was high to moderate. Conclusions Absolute effects of STAN were minor and the clinical significance of the observed reduction in metabolic acidosis is questioned. There is insufficient evidence to state that STAN as an adjunct to CTG leads to important clinical benefits compared with CTG alone. |
| format | Article |
| id | doaj-art-15ebcb18afba4602b239e2571353f5d2 |
| institution | DOAJ |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-15ebcb18afba4602b239e2571353f5d22025-08-20T03:22:21ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122024-03-01103343744810.1111/aogs.14752ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta‐analysis of randomized trialsEllen Blix0Kjetil Gundro Brurberg1Eirik Reierth2Liv Merete Reinar3Pål Øian4Faculty of Health Sciences Oslo Metropolitan University Oslo NorwayThe Norwegian Institute of Public Health Oslo NorwayScience and Health Library University Library, UiT The Arctic University of Norway Tromsø NorwayThe Norwegian Institute of Public Health Oslo NorwayDepartment of Obstetrics and Gynecology University Hospital of North Norway Tromsø NorwayAbstract Introduction ST waveform analysis (STAN) was introduced as an adjunct to cardiotocography (CTG) to improve neonatal and maternal outcomes. The aim of the present study was to quantify the efficacy of STAN vs CTG and assess the quality of the evidence using GRADE. Material and methods We performed systematic literature searches to identify randomized controlled trials and assessed included studies for risk of bias. We performed meta‐analyses, calculating pooled risk ratio (RR) or Peto odds ratio (OR). We also performed post hoc trial sequential analyses for selected outcomes to assess the risk of false‐positive results and the need for additional studies. Results Nine randomized controlled trials including 28 729 women were included in the meta‐analysis. There were no differences between the groups in operative deliveries for fetal distress (10.9 vs 11.1%; RR 0.96; 95% confidence interval [CI] 0.82–1.11). STAN was associated with a significantly lower rate of metabolic acidosis (0.45% vs 0.68%; Peto OR 0.66; 95% CI 0.48–0.90). Accordingly, 441 women need to be monitored with STAN instead of CTG alone to prevent one case of metabolic acidosis. Women allocated to STAN had a reduced risk of fetal blood sampling compared with women allocated to conventional CTG monitoring (12.5% vs 19.6%; RR 0.62; 95% CI 0.49–0.80). The quality of the evidence was high to moderate. Conclusions Absolute effects of STAN were minor and the clinical significance of the observed reduction in metabolic acidosis is questioned. There is insufficient evidence to state that STAN as an adjunct to CTG leads to important clinical benefits compared with CTG alone.https://doi.org/10.1111/aogs.14752cardiotocographyfetal electrocardiographyintrapartum fetal monitoringliving systematic reviewmeta‐analysisST waveform analysis |
| spellingShingle | Ellen Blix Kjetil Gundro Brurberg Eirik Reierth Liv Merete Reinar Pål Øian ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta‐analysis of randomized trials Acta Obstetricia et Gynecologica Scandinavica cardiotocography fetal electrocardiography intrapartum fetal monitoring living systematic review meta‐analysis ST waveform analysis |
| title | ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta‐analysis of randomized trials |
| title_full | ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta‐analysis of randomized trials |
| title_fullStr | ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta‐analysis of randomized trials |
| title_full_unstemmed | ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta‐analysis of randomized trials |
| title_short | ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta‐analysis of randomized trials |
| title_sort | st waveform analysis vs cardiotocography alone for intrapartum fetal monitoring an updated systematic review and meta analysis of randomized trials |
| topic | cardiotocography fetal electrocardiography intrapartum fetal monitoring living systematic review meta‐analysis ST waveform analysis |
| url | https://doi.org/10.1111/aogs.14752 |
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