Scientific and clinical evidence for the use of fetal ECG ST segment analysis (STAN)

Acta Obstetricia et Gynecologica Scandinavica

Volumn 93, Issue 6, 2014, Pages 533-538

  Steer, Philip J ^a   Hvidman, Lone Egly ^b  

^a CHELSEA AND WESTMINSTER HOSPITAL   (United Kingdom)

^b AARHUS UNIVERSITY HOSPITAL   (Denmark)

Author keywords

cardiotocography; fetal electrocardiogram; intrapartum fetal monitoring; ST analysis of the fetal ECG; STAN

Indexed keywords

ACIDOSIS; APGAR SCORE; ARTICLE; CESAREAN SECTION; FETAL SCALP ELECTRODE; FETUS BLOOD SAMPLING; FETUS ELECTROCARDIOGRAPHY; FETUS HEART RATE; FETUS MONITORING; FETUS OUTCOME; HUMAN; META ANALYSIS (TOPIC); PREMATURE FETUS MEMBRANE RUPTURE; PRIORITY JOURNAL; ST SEGMENT; SYSTEMATIC REVIEW (TOPIC);

CARDIOTOCOGRAPHY; FETAL ELECTROCARDIOGRAM; INTRAPARTUM FETAL MONITORING; ST ANALYSIS OF THE FETAL ECG; STAN;

CARDIOTOCOGRAPHY; ELECTROCARDIOGRAPHY; FEMALE; HUMANS; LABOR, OBSTETRIC; PREGNANCY; REPRODUCIBILITY OF RESULTS; SENSITIVITY AND SPECIFICITY;

EID: 84901687535     PISSN: 00016349     EISSN: 16000412     Source Type: Journal    
DOI: 10.1111/aogs.12369     Document Type: Article

References (39)

1. Cremer M,. Uber die direkte Ableitung der Akonsstrome des menschlichen Herzens vom Oesophagus, and uber das Elektrokardiogramm des fotus. [About the direct derivation of Akon's current of the human heart from the esophagus, and about the electrocardiogram of the fetus]. In German. Munch Med Wochenschr. 1906; 53: 811.
2. Smyth CN,. Experimental electrocardiography of the foetus. Lancet. 1953; 1: 1124-6.
3. Southern EM,. Electrocardiography and phonocardiography of the foetal heart. J Obstet Gynaecol Br Emp. 1954; 61: 231-7.
4. Southern EM,. Fetal anoxia and its possible relation to changes in the prenatal fetal electrocardiogram. Am J Obstet Gynecol. 1957; 73: 233-47.
5. Symonds EM,. Configuration of the fetal electrocardiogram in relation to fetal acid-base balance and plasma electrolytes. J Obstet Gynaecol Br Commonw. 1971; 78: 957-70.
6. Marvell CJ, Kirk DL, Jenkins HML, Symonds EM,. The normal condition of the fetal electrocardiogram during labour. Br J Obstet Gynaecol. 1980; 87: 786-96.
7. Murray HG,. The fetal electrocardiogram: current clinical developments in Nottingham. J Perinat Med. 1986; 14: 399-403.
8. Rosen KG, Kjellmer I,. Changes in the fetal heart rate and ECG during hypoxia. Acta Physiol Scand. 1975; 93: 59-66.
9. Lilja H, Greene KR, Karlsson K, Rosen KG,. ST waveform changes of the fetal electrocardiogram during labour-a clinical study. Br J Obstet Gynaecol. 1985; 92: 611-617.
10. Jenkins HML, Symonds EM, Kirk DL, Smith PR,. Can fetal electrocardiography improve the prediction of intrapartum fetal acidosis? Br J Obstet Gynaecol. 1986; 93: 6-12.
11. Reed NN, Mohajer MP, Sahota DS, James DK, Symonds EM,. The potential impact of PR interval analysis of the fetal electrocardiogram (FECG) on intrapartum fetal monitoring. Eur J Obstet Gynecol Reprod Biol. 1996; 68: 87-92.
12. Rosen KG, Luzietti R,. The fetal electrocardiogram: ST waveform analysis during labour. J Perinat Med. 1994; 22: 501-12.
13. Westgate J, Harris M, Curnow JS, Greene KR,. Plymouth randomized trial of cardiotocogram only versus ST waveform plus cardiotocogram for intrapartum monitoring in 2400 cases. Am J Obstet Gynecol. 1993; 169: 1151-60.
14. Amer-Wahlin I, Hellsten C, Noren H, Hagberg H, Herbst A, Kjellmer I, et al. Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial. Lancet. 2001; 358: 534-8.
15. Lund University. Press release regarding alleged research fraud 22nd October 2008. Available online at: http://www.med.lu.se/english/research/press- release-22-october-2008 (accessed April 4, 2014).
16. Lund University. Press release: a decision relating to suspected misconduct in research has been made. Available online at: http://www.med.lu.se/ english/research/press-release-16-september-2010 (accessed April 4, 2014).
17. Amer-Wahlin I, Kjellmer I, Marsal K, Olofsson P, Rosen KG,. Swedish randomized controlled trial of cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram revisited: analysis of data according to standard versus modified intention-to-treat principle. Acta Obstet Gynecol Scand. 2011; 90: 990-6.
18. Noren H, Blad S, Carlsson A, Flisberg A, Gustavsson A, Lilja H, et al. STAN in clinical practice-the outcome of 2 years of regular use in the city of Gothenburg. Am J Obstet Gynecol. 2006; 195: 7-15.
19. Devoe LD, Ross M, Wilde C, Beal M, Lysikewicz A, Maier J, et al. United States multicenter clinical usage study of the STAN 21 electronic fetal monitoring system. Am J Obstet Gynecol. 2006; 195: 729-34.
20. Westerhuis ME, van Horen E, Kwee A, van der Tweel I, Visser GH, Moons KG,. Inter- and intra-observer agreement of intrapartum ST analysis of the fetal electrocardiogram in women monitored by STAN. BJOG. 2009; 116: 545-51.
21. Ojala K, Vaarasmaki M, Makikallio K, Valkama M, Tekay A,. A comparison of intrapartum automated fetal electrocardiography and conventional cardiotocography-a randomised controlled study. BJOG. 2006; 113: 419-23.
22. Vayssiere C, David E, Meyer N, Haberstich R, Sebahoun V, Roth E, et al. A French randomized controlled trial of ST-segment analysis in a population with abnormal cardiotocograms during labor. Am J Obstet Gynecol. 2007; 197: 299-6.
23. Westerhuis M, Kwee A, van Ginkel A, Drogtrop A, Gyselaers W, Visser G,. Limitations of ST analysis in clinical practice: three cases of intrapartum metabolic acidosis. BJOG. 2007; 114: 1194-201.
24. Doria V, Papageorghiou AT, Gustafsson A, Ugwumadu A, Farrer K, Arulkumaran S,. Review of the first 1502 cases of ECG-ST waveform analysis during labour in a teaching hospital. BJOG. 2007; 114: 1202-7.
25. Melin M, Bonnevier A, Cardell M, Hogan L, Herbst A,. Changes in the ST-interval segment of the fetal electrocardiogram in relation to acid-base status at birth. BJOG. 2008; 115: 1669-75.
26. Vayssiere C, Tsatsaris V, Pirrello O, Cristini C, Arnaud C, Goffinet F,. Inter-observer agreement in clinical decision-making for abnormal cardiotocogram (CTG) during labour: a comparison between CTG and CTG plus STAN. BJOG. 2009; 116: 1081-7.
27. Ragupathy K, Ismail F, Nicoll AE,. The use of STAN monitoring in the labour ward. J Obstet Gynaecol. 2010; 30: 465-9.
28. Doret M, Massoud M, Constans A, Gaucherand P,. Use of peripartum ST analysis of fetal electrocardiogram without blood sampling: a large prospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2011; 156: 35-40.
29. Massoud M, Bloc F, Gaucherand P, Doret M,. How deviations from STAN guidelines contribute to operative delivery for suspected fetal distress. Eur J Obstet Gynecol Reprod Biol. 2012; 162: 45-9.
30. Neilson JP,. Fetal electrocardiogram (ECG) for fetal monitoring during labour. Cochrane Database Syst Rev. 2013; 5: CD000116.
31. Potti S, Berghella V,. ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a meta-analysis of randomized trials. Am J Perinatol. 2012; 29: 657-64.
32. Yli BM, Kessler J, Eikeland T, Hustad BL, Dragnes W, Henriksen T,. What is the gold standard for intrapartum fetal monitoring? Acta Obstet Gynecol Scand. 2012; 91: 1011-14.
33. Amer-Wahlin I, Arulkumaran S, Hagberg H, Marsal K, Visser GHA,. Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance. BJOG. 2007; 114: 1191-3.
34. Pettker CM, Thung SF, Norwitz ER, Buhimschi CS, Raab CA, Copel JA, et al. Impact of a comprehensive patient safety strategy on obstetric adverse events. Am J Obstet Gynecol. 2009; 200: e1-8.
35. Clark SL, Belfort MA, Dildy GA, Meyers JA,. Reducing obstetric litigation through alterations in practice patterns. Obstet Gynecol. 2008; 112: 1279-83.
36. Westerhuis ME, Visser GH, Moons KG, van Beek E, Benders MJ, Bijvoet SM, et al. Cardiotocography plus ST analysis of fetal electrocardiogram compred with cardiotocography only for intrapartum monitoring: a randomized controlled trial. Obstet Gynecol. 2010; 115: 1173-80.
37. Norén H, Carlsson RN,. Reduced prevalence of metabolic acidosis at birth: an analysis of established STAN usage in the total population of deliveries in a Swedish district hospital. Am J Obstet Gynecol. 2010; 202: e1-7.
38. Kessler J, Moster D, Albrechtsen S,. Intrapartum monitoring of high-risk deliveries with ST-analysis of the fetal electrocardiogram: an observational study of 6010 deliveries. Acta Obstet Gynecol Scand. 2013; 92: 75-84.
39. Danish Quality Database for Births. 2012. Available online at: https://www.sundhed.dk/content/cms/66/4666-dkf-%C3%A5rsrapport-2012-2013-final. pdf (accessed April 4, 2014).