ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring : An updated systematic review and meta-analysis of randomized trials
© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG)..
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.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:103 |
|---|---|
| Enthalten in: |
Acta obstetricia et gynecologica Scandinavica - 103(2024), 3 vom: 10. Feb., Seite 437-448 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Blix, Ellen [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Cardiotocography |
|---|
| Anmerkungen: |
Date Completed 16.02.2024 Date Revised 17.02.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1111/aogs.14752 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM365843296 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM365843296 | ||
| 003 | DE-627 | ||
| 005 | 20240217232254.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/aogs.14752 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1297.xml |
| 035 | |a (DE-627)NLM365843296 | ||
| 035 | |a (NLM)38093630 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Blix, Ellen |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring |b An updated systematic review and meta-analysis of randomized trials |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 16.02.2024 | ||
| 500 | |a Date Revised 17.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a ST waveform analysis | |
| 650 | 4 | |a cardiotocography | |
| 650 | 4 | |a fetal electrocardiography | |
| 650 | 4 | |a intrapartum fetal monitoring | |
| 650 | 4 | |a living systematic review | |
| 650 | 4 | |a meta-analysis | |
| 700 | 1 | |a Brurberg, Kjetil Gundro |e verfasserin |4 aut | |
| 700 | 1 | |a Reierth, Eirik |e verfasserin |4 aut | |
| 700 | 1 | |a Reinar, Liv Merete |e verfasserin |4 aut | |
| 700 | 1 | |a Øian, Pål |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Acta obstetricia et gynecologica Scandinavica |d 1947 |g 103(2024), 3 vom: 10. Feb., Seite 437-448 |w (DE-627)NLM000123765 |x 1600-0412 |7 nnns |
| 773 | 1 | 8 | |g volume:103 |g year:2024 |g number:3 |g day:10 |g month:02 |g pages:437-448 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/aogs.14752 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 103 |j 2024 |e 3 |b 10 |c 02 |h 437-448 | ||