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Changes in the ST-interval segment of the fetal electrocardiogram in relation to acid-base status at birth.

Melin, M; Bonnevier, A; Cardell, Monika LU ; Hogan, L and Herbst, Andreas LU (2008) In BJOG : an international journal of obstetrics and gynaecology 115(13). p.1669-1675
Abstract
Objective To assess the occurrence of ST-interval segment changes of the fetal electrocardiogram (ECG) and cardiotocographic (CTG) abnormalities preceding acidaemia at birth. Design Case-control study. Setting University hospital labour ward. Sample Newborns with severe cord artery metabolic acidaemia (pH < 7.00 and lactate >/= 10 mmol/l; n= 24), moderate metabolic acidaemia (pH 7.00-7.09 and lactate >/= 10; n= 48), acidaemia (pH 7.00-7.09; n= 52), pre-acidaemia (pH 7.10-7.19; n= 265), and controls (pH >/= 7.20; n= 117). Methods Monitoring traces were assessed blinded to outcome. Main outcome measures CTG and ST changes. Results Any ST event occurred significantly more often among cases with severe (79%) and moderate (75%)... (More)
Objective To assess the occurrence of ST-interval segment changes of the fetal electrocardiogram (ECG) and cardiotocographic (CTG) abnormalities preceding acidaemia at birth. Design Case-control study. Setting University hospital labour ward. Sample Newborns with severe cord artery metabolic acidaemia (pH < 7.00 and lactate >/= 10 mmol/l; n= 24), moderate metabolic acidaemia (pH 7.00-7.09 and lactate >/= 10; n= 48), acidaemia (pH 7.00-7.09; n= 52), pre-acidaemia (pH 7.10-7.19; n= 265), and controls (pH >/= 7.20; n= 117). Methods Monitoring traces were assessed blinded to outcome. Main outcome measures CTG and ST changes. Results Any ST event occurred significantly more often among cases with severe (79%) and moderate (75%) metabolic acidaemia than among controls (50%). The difference was restricted to baseline T/QRS rises and to the second stage of labour, during which any event only occurred significantly more often among cases with severe metabolic acidaemia (62%) than among controls (38%). ST events coincided with abnormal CTG patterns in 67, 44, 40, and 28% of cases with severe and moderate metabolic acidaemia, acidaemia, and pre-acidaemia, respectively, and in 12% of controls. ST events with intermediary CTG were similarly frequent in the case groups (0-6%) as in the controls (4%). The ST guidelines stated intervention in 96, 62, 73, and 49% of case groups and 23% of controls. Conclusions Only two of three cases with severe and less than half of cases with moderate metabolic acidaemia were preceded by ST events coinciding with CTG abnormalities. It is therefore important to intervene for long-lasting, rapidly deteriorating or marked (preterminal) CTG abnormalities, also in the absence of ST events. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BJOG : an international journal of obstetrics and gynaecology
volume
115
issue
13
pages
1669 - 1675
publisher
Wiley-Blackwell
external identifiers
  • WOS:000260748300012
  • PMID:19035941
  • Scopus:55949092958
ISSN
1471-0528
DOI
10.1111/j.1471-0528.2008.01949.x
language
English
LU publication?
yes
id
c3db32bc-b9b9-49f6-9174-4140ac65d4f2 (old id 1271055)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19035941?dopt=Abstract
date added to LUP
2008-12-03 13:44:21
date last changed
2016-10-30 04:35:24
@misc{c3db32bc-b9b9-49f6-9174-4140ac65d4f2,
  abstract     = {Objective To assess the occurrence of ST-interval segment changes of the fetal electrocardiogram (ECG) and cardiotocographic (CTG) abnormalities preceding acidaemia at birth. Design Case-control study. Setting University hospital labour ward. Sample Newborns with severe cord artery metabolic acidaemia (pH &lt; 7.00 and lactate &gt;/= 10 mmol/l; n= 24), moderate metabolic acidaemia (pH 7.00-7.09 and lactate &gt;/= 10; n= 48), acidaemia (pH 7.00-7.09; n= 52), pre-acidaemia (pH 7.10-7.19; n= 265), and controls (pH &gt;/= 7.20; n= 117). Methods Monitoring traces were assessed blinded to outcome. Main outcome measures CTG and ST changes. Results Any ST event occurred significantly more often among cases with severe (79%) and moderate (75%) metabolic acidaemia than among controls (50%). The difference was restricted to baseline T/QRS rises and to the second stage of labour, during which any event only occurred significantly more often among cases with severe metabolic acidaemia (62%) than among controls (38%). ST events coincided with abnormal CTG patterns in 67, 44, 40, and 28% of cases with severe and moderate metabolic acidaemia, acidaemia, and pre-acidaemia, respectively, and in 12% of controls. ST events with intermediary CTG were similarly frequent in the case groups (0-6%) as in the controls (4%). The ST guidelines stated intervention in 96, 62, 73, and 49% of case groups and 23% of controls. Conclusions Only two of three cases with severe and less than half of cases with moderate metabolic acidaemia were preceded by ST events coinciding with CTG abnormalities. It is therefore important to intervene for long-lasting, rapidly deteriorating or marked (preterminal) CTG abnormalities, also in the absence of ST events.},
  author       = {Melin, M and Bonnevier, A and Cardell, Monika and Hogan, L and Herbst, Andreas},
  issn         = {1471-0528},
  language     = {eng},
  number       = {13},
  pages        = {1669--1675},
  publisher    = {ARRAY(0xaba93e8)},
  series       = {BJOG : an international journal of obstetrics and gynaecology},
  title        = {Changes in the ST-interval segment of the fetal electrocardiogram in relation to acid-base status at birth.},
  url          = {http://dx.doi.org/10.1111/j.1471-0528.2008.01949.x},
  volume       = {115},
  year         = {2008},
}