Fetal scalp pH and ST analysis of the fetal ECG as an adjunct to CTG. A multi-center, observational study
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Andreas K. Luttkus
Abstract
Objective: To evaluate the relationships between scalp-pH and CTG plus ST waveform analysis of the fetal ECG (STAN) clinical guidelines as indicators of intrapartum hypoxia in term fetuses born with cord artery acidemia.
Study design: Data from 6999 term deliveries monitored by the STAN® S 21 as part of an EU multi-center study on clinical implementation of the STAN methodology for intrapartum fetal surveillance were analyzed. We identified 911 cases where a scalp-pH was obtained, including 53 cases with cord artery acidemia (pH < 7.06). Lag times between ST events and scalp-pH and time to delivery were related to cord artery metabolic and respiratory acidosis and neonatal outcome.
Results: 43 fetuses were identified by CTG plus ST as being in need of intervention 31 (25–46) minutes before delivery (median, 95% Cl). In five, no indications were given and in another five there were inadequate data. Fifteen cases with metabolic acidosis required special neonatal care, all 14 cases adequately monitored on STAN had indications to intervene for 19 minutes or more. In 30 adequately recorded cases, fetal blood sampling (FBS) was obtained within the last hour of labor. In 22 cases, FBS was obtained 13 (7–24) minutes after STAN guidelines had indicated abnormality and in eight no ST changes had occurred at time of FBS. The corresponding FBS data were pH 7.10 (7.01–7.15) and pH 7.21 (7.08–7.31), respectively, P = 0.01. In cases of metabolic acidosis, scalp-pH fell 0.01 units per minute after a baseline T/QRS rise was recorded during the second stage of labor. Apart from one newborn that died at 2 h from E. Coli septicemia, none of the neonates were affected neurologically.
Conclusion: Cardiotocography plus ST analysis provides accurate information about intrapartum hypoxia similar to that obtained by scalp-pH.
References
1 Amer-Wahlin I, C Hellsten, H Norén, H Hagberg, A Herbst, I Kjellmer I et al.: Intrapartum fetal monitoring: Cardiotocography versus cardiotocography plus ST analysis of the fetal ECG. A Swedish randomized controlled trial. Lancet358 (2001) 534Search in Google Scholar
2 Amer-Wahlin I, P Bördahl, T Eikeland, C Hellsten, H Norén, T Sörnes, KG Rosén: ST analysis of the fetal electrocardiogram during labor: Nordic observational multicenter study. J Mat Fet Neonat Med12 (2002) 260Search in Google Scholar
3 Arulkumaran S, H Lilja, K Lindecrantz et al.: Fetal ECG waveform analysis should improve fetal surveillance in labor. J Perinat Med18 (1990) 13Search in Google Scholar
4 Clark SL, RH Paul: Intrapartum fetal surveillance: the role of fetal scalp blood sampling. Am J Obstet Gynecol153 (1985) 717Search in Google Scholar
5 Hökegård KH, BO Eriksson, I Kjellmer, R Magno, KG Rosén: Myocardial metabolism in relation to electrocardiographic changes and cardiac function during graded hypoxia in the fetal lamb. Acta Physiol Scand113 (1981) 1Search in Google Scholar
6 Impey L, M Reynolds, K MacQuillan, S Gates, J Murphy, O Sheil: Admission cardiotocography: a randomised controlled trial. Lancet361 (2003) 465Search in Google Scholar
7 Luzietti R, R Erkkola, U Hasbargen, LA Mattsson, JM Thoulon, KG Rosén: European Community multi Center Trial “Fetal ECG Analysis During Labor”: ST plus CTG analysis. J Perinat Med27 (1999) 431Search in Google Scholar
8 Norén H, I Amer-Wahlin, H Hagberg, A Herbst, I Kjellmer, K Marsal, P Olofsson, KG Rosén: Fetal electrocardiography in labor and neonatal outcome: Data from the Swedish randomized controlled trial on intrapartum fetal monitoring. Am J Obstet Gynecol188 (2003) 183Search in Google Scholar
9 Parer JT, T King: Fetal heart rate monitoring: is it salvageable? Am J Obstet Gynecol182 (2000) 982Search in Google Scholar
10 Rosén KG, A Dagbjartsson, BA Henriksson, H Lagercrantz, I Kjellmer: The relationship between circulating catecholamines and ST waveform in the fetal lamb electrocardiogram during hypoxia. Am J Obstet Gynaecol149 (1984) 190Search in Google Scholar
11 Saling E: Fetal scalp blood analysis. J Perinat Med9 (1981) 16510.1515/jpme.1981.9.4.165Search in Google Scholar PubMed
12 Siggaard-Andersen O: An acid base chart for arterial blood with normal and pathophysiological reference areas. Scand J Clin Lab Invest27 (1971) 23910.3109/00365517109080214Search in Google Scholar PubMed
13 Thacker SB, D Stroup, M Chang: Continuous electronic heart rate monitoring for fetal assessment during labor. Cochrane Database Syst Rev CD000063 (2001)10.1002/14651858.CD000063Search in Google Scholar PubMed
14 Westgate J, KR Greene: How well is fetal blood sampling used in clinical practice? Br J Obstet Gynaecol101 (1994) 250Search in Google Scholar
© Walter de Gruyter
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- Author Index
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- Fetal scalp pH and ST analysis of the fetal ECG as an adjunct to CTG. A multi-center, observational study
- Effects of nitric oxide and prostacyclin on hemodynamic response by big endothelin-1 in near term fetal sheep
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- Prolonged fetal bradycardia as the presenting clinical sign in Streptococcus agalactiae chorioamnionitis
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- Myocardial infarction in early pregnancy
- The baby and the bathwater – a comment
- Reply to the opinion paper “The baby or the bathwater: which one should be discarded?”
Articles in the same Issue
- Author Index
- Subject Index
- Contents
- Difficult delivery of the impacted fetal head during cesarean section: intraoperative disengagement dystocia
- Breech presenting twin A: is vaginal delivery safe?
- Maternal serum interleukin-1β, -6 and -8 levels and potential determinants in pregnancy and peripartum
- Comparison between HELLP syndrome, chronic hypertension, and superimposed preeclampsia on chronic hypertension without HELLP syndrome
- Fetal scalp pH and ST analysis of the fetal ECG as an adjunct to CTG. A multi-center, observational study
- Effects of nitric oxide and prostacyclin on hemodynamic response by big endothelin-1 in near term fetal sheep
- Strategy for management of newborns with cervical teratoma
- Predicting neonatal outcomes: birthweight, body mass index or ponderal index?
- Markers of platelets activation, CD 62P and soluble P-selectin in healthy term neonates
- Detection of parvovirus B19, cytomegalovirus and enterovirus infections in cases of intrauterine fetal death
- Plasma endothelin-1 and clinical manifestations of neonatal sepsis
- Noncompaction of the left ventricular myocardium diagnosed in pregnant woman and neonate
- Ventricular bigeminy misdiagnosed as fetal bradycardia by cardiotocography – the value of non-invasive fetal electrocardiography
- Prolonged fetal bradycardia as the presenting clinical sign in Streptococcus agalactiae chorioamnionitis
- Changes of blood pressure and heart rate variability precede a grand mal seizure in a pregnant woman
- Myocardial infarction in early pregnancy
- The baby and the bathwater – a comment
- Reply to the opinion paper “The baby or the bathwater: which one should be discarded?”
