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A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part I: the randomized controlled trials.

Olofsson, Per LU ; Ayres-de-Campos, Diogo; Kessler, Jörg; Tendal, Britta; Yli, Branka M and Devoe, Lawrence (2014) In Acta Obstetricia et Gynecologica Scandinavica 93(6). p.556-568
Abstract
We reappraised the five randomized controlled trials (RCTs) that compared CTG+ST vs. CTG. The numbers enrolled ranged from 5681 (Dutch RCT) to 799 (French RCT). The Swedish RCT (N=5049) was the only trial adequately powered to show a difference in metabolic acidosis, and the Plymouth RCT (N=2434) was only powered to show a difference in operative delivery for fetal distress. There were considerable differences in study design: the French RCT used different inclusion criteria, and the Finnish RCT (N=1483) used a different metabolic acidosis definition. In the CTG+ST study arms, the larger Plymouth, Swedish and Dutch trials showed lower operative delivery and metabolic acidosis rates, while the smaller Finnish and French trials showed minor... (More)
We reappraised the five randomized controlled trials (RCTs) that compared CTG+ST vs. CTG. The numbers enrolled ranged from 5681 (Dutch RCT) to 799 (French RCT). The Swedish RCT (N=5049) was the only trial adequately powered to show a difference in metabolic acidosis, and the Plymouth RCT (N=2434) was only powered to show a difference in operative delivery for fetal distress. There were considerable differences in study design: the French RCT used different inclusion criteria, and the Finnish RCT (N=1483) used a different metabolic acidosis definition. In the CTG+ST study arms, the larger Plymouth, Swedish and Dutch trials showed lower operative delivery and metabolic acidosis rates, while the smaller Finnish and French trials showed minor differences in operative delivery and higher metabolic acidosis rates. We conclude that the differences in outcomes are likely due to considerable differences in study design and size. This will enhance heterogeneity effects in any subsequent meta-analysis. This article is protected by copyright. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Obstetricia et Gynecologica Scandinavica
volume
93
issue
6
pages
556 - 568
publisher
Wiley-Blackwell
external identifiers
  • pmid:24797452
  • wos:000337566200007
  • scopus:84901622074
ISSN
1600-0412
DOI
10.1111/aogs.12413
language
English
LU publication?
yes
id
748e154e-5d9e-40e3-8fc1-c3add0f3737b (old id 4455828)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24797452?dopt=Abstract
date added to LUP
2014-06-03 20:11:05
date last changed
2017-07-09 03:10:02
@article{748e154e-5d9e-40e3-8fc1-c3add0f3737b,
  abstract     = {We reappraised the five randomized controlled trials (RCTs) that compared CTG+ST vs. CTG. The numbers enrolled ranged from 5681 (Dutch RCT) to 799 (French RCT). The Swedish RCT (N=5049) was the only trial adequately powered to show a difference in metabolic acidosis, and the Plymouth RCT (N=2434) was only powered to show a difference in operative delivery for fetal distress. There were considerable differences in study design: the French RCT used different inclusion criteria, and the Finnish RCT (N=1483) used a different metabolic acidosis definition. In the CTG+ST study arms, the larger Plymouth, Swedish and Dutch trials showed lower operative delivery and metabolic acidosis rates, while the smaller Finnish and French trials showed minor differences in operative delivery and higher metabolic acidosis rates. We conclude that the differences in outcomes are likely due to considerable differences in study design and size. This will enhance heterogeneity effects in any subsequent meta-analysis. This article is protected by copyright. All rights reserved.},
  author       = {Olofsson, Per and Ayres-de-Campos, Diogo and Kessler, Jörg and Tendal, Britta and Yli, Branka M and Devoe, Lawrence},
  issn         = {1600-0412},
  language     = {eng},
  number       = {6},
  pages        = {556--568},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Obstetricia et Gynecologica Scandinavica},
  title        = {A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part I: the randomized controlled trials.},
  url          = {http://dx.doi.org/10.1111/aogs.12413},
  volume       = {93},
  year         = {2014},
}