The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population study
Abstract Introduction ST segment analysis (STAN) of the fetal electrocardiogram was introduced as an adjunct to cardiotocography for intrapartum fetal monitoring 30 years ago. We examined the impact of the introduction of STAN on changes in the occurrence of fetal and neonatal deaths, Apgar scores o...
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Wiley
2022-07-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14347 |
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| author | Ellen Blix Anne Eskild Irene Skau Jostein Grytten |
| author_facet | Ellen Blix Anne Eskild Irene Skau Jostein Grytten |
| author_sort | Ellen Blix |
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| description | Abstract Introduction ST segment analysis (STAN) of the fetal electrocardiogram was introduced as an adjunct to cardiotocography for intrapartum fetal monitoring 30 years ago. We examined the impact of the introduction of STAN on changes in the occurrence of fetal and neonatal deaths, Apgar scores of <7 at 5 min, intrapartum cesarean sections, and instrumental vaginal deliveries while controlling for time‐ and hospital‐specific trends and maternal risk factors. Material and Methods Data were retrieved from the Medical Birth Registry of Norway from 1985 to 2014. Individual data were linked to the Education Registry and the Central Person Registry. The study sample included 1 132 022 singleton births with a gestational age of 36 weeks or beyond. Information about the year of STAN introduction was collected from every birth unit in Norway using a questionnaire. Our data structure consisted of a hospital‐year panel. We applied a linear probability model with hospital‐fixed effects and with adjustment for potentially confounding factors. The prevalence of the outcomes before and after the introduction of STAN were compared within each birth unit. Results In total, 23 birth units, representing 76% of all births in Norway, had introduced the STAN technology. During the study period, stillbirths declined from 2.6 to 1.9 per 1000 births, neonatal deaths declined from 1.7 to 0.7 per 1000 live births, babies with Apgar score <7 at 5 min after birth increased from 7.4 to 9.5 per 1000 births, intrapartum cesarean sections increased from 6.4% to 9.5%, and instrumental vaginal deliveries increased from 7.8% to 10.9%. Our analyses found that the introduction of STAN was not associated with the decline in proportion of stillbirths (p =0.76) and neonatal deaths (p =0.76) or with the increase in intrapartum cesarean sections (p =0.92) and instrumental vaginal deliveries (p =0.78). However, it was associated with the increased occurrence of Apgar score <7 at 5 min (p =0.01). Conclusions There is no evidence that the introduction of STAN contributed to changes in the rates of stillbirths, neonatal deaths, intrapartum cesarean sections, or instrumental vaginal deliveries. There was an association between the introduction of STAN and a small increase in neonates with low Apgar scores. |
| format | Article |
| id | doaj-art-918ad431ec9e4df08611b2f99e5f43e6 |
| institution | Kabale University |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-918ad431ec9e4df08611b2f99e5f43e62025-08-20T03:30:53ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122022-07-01101780981810.1111/aogs.14347The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population studyEllen Blix0Anne Eskild1Irene Skau2Jostein Grytten3Faculty of Health Sciences OsloMet – Oslo Metropolitan University Oslo NorwayAkershus University Hospital Lørenskog NorwayDepartment of Community Dentistry University of Oslo Oslo NorwayDepartment of Community Dentistry University of Oslo Oslo NorwayAbstract Introduction ST segment analysis (STAN) of the fetal electrocardiogram was introduced as an adjunct to cardiotocography for intrapartum fetal monitoring 30 years ago. We examined the impact of the introduction of STAN on changes in the occurrence of fetal and neonatal deaths, Apgar scores of <7 at 5 min, intrapartum cesarean sections, and instrumental vaginal deliveries while controlling for time‐ and hospital‐specific trends and maternal risk factors. Material and Methods Data were retrieved from the Medical Birth Registry of Norway from 1985 to 2014. Individual data were linked to the Education Registry and the Central Person Registry. The study sample included 1 132 022 singleton births with a gestational age of 36 weeks or beyond. Information about the year of STAN introduction was collected from every birth unit in Norway using a questionnaire. Our data structure consisted of a hospital‐year panel. We applied a linear probability model with hospital‐fixed effects and with adjustment for potentially confounding factors. The prevalence of the outcomes before and after the introduction of STAN were compared within each birth unit. Results In total, 23 birth units, representing 76% of all births in Norway, had introduced the STAN technology. During the study period, stillbirths declined from 2.6 to 1.9 per 1000 births, neonatal deaths declined from 1.7 to 0.7 per 1000 live births, babies with Apgar score <7 at 5 min after birth increased from 7.4 to 9.5 per 1000 births, intrapartum cesarean sections increased from 6.4% to 9.5%, and instrumental vaginal deliveries increased from 7.8% to 10.9%. Our analyses found that the introduction of STAN was not associated with the decline in proportion of stillbirths (p =0.76) and neonatal deaths (p =0.76) or with the increase in intrapartum cesarean sections (p =0.92) and instrumental vaginal deliveries (p =0.78). However, it was associated with the increased occurrence of Apgar score <7 at 5 min (p =0.01). Conclusions There is no evidence that the introduction of STAN contributed to changes in the rates of stillbirths, neonatal deaths, intrapartum cesarean sections, or instrumental vaginal deliveries. There was an association between the introduction of STAN and a small increase in neonates with low Apgar scores.https://doi.org/10.1111/aogs.14347Apgar scoreCTGfetal deathfetal electrocardiogramintrapartum fetal monitoringnational registry study |
| spellingShingle | Ellen Blix Anne Eskild Irene Skau Jostein Grytten The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population study Acta Obstetricia et Gynecologica Scandinavica Apgar score CTG fetal death fetal electrocardiogram intrapartum fetal monitoring national registry study |
| title | The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population study |
| title_full | The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population study |
| title_fullStr | The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population study |
| title_full_unstemmed | The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population study |
| title_short | The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population study |
| title_sort | impact of the introduction of intrapartum fetal ecg st segment analysis a population study |
| topic | Apgar score CTG fetal death fetal electrocardiogram intrapartum fetal monitoring national registry study |
| url | https://doi.org/10.1111/aogs.14347 |
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