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The added predictive value of biphasic events in ST analysis of the fetal electrocardiogram for intrapartumfetal monitoring

Becker, Jeroen H.; Krikhaar, Anniek; Schuit, Ewoud; Martendal, Annika; Marsal, Karel LU ; Kwee, Anneke; Visser, Gerard H. A. and Amer-Wahlin, Isis (2015) In Acta Obstetricia et Gynecologica Scandinavica 94(2). p.175-182
Abstract
ObjectiveTo study the predictive value of biphasic ST-events for interventions for suspected fetal distress and adverse neonatal outcome, when using ST-analysis of the fetal electrocardiogram (FECG) for intrapartum fetal monitoring. DesignProspective cohort study. SettingThree academic hospitals in Sweden. PopulationWomen in labor with a high-risk singleton fetus in cephalic position beyond 36weeks of gestation. MethodsIn women in labor who were monitored with conventional cardiotocography, ST-waveform analysis was recorded and concealed. Traces with biphasic ST-events of the FECG (index) were compared with traces without biphasic events of the FECG. The ability of biphasic events to predict interventions for suspected fetal distress and... (More)
ObjectiveTo study the predictive value of biphasic ST-events for interventions for suspected fetal distress and adverse neonatal outcome, when using ST-analysis of the fetal electrocardiogram (FECG) for intrapartum fetal monitoring. DesignProspective cohort study. SettingThree academic hospitals in Sweden. PopulationWomen in labor with a high-risk singleton fetus in cephalic position beyond 36weeks of gestation. MethodsIn women in labor who were monitored with conventional cardiotocography, ST-waveform analysis was recorded and concealed. Traces with biphasic ST-events of the FECG (index) were compared with traces without biphasic events of the FECG. The ability of biphasic events to predict interventions for suspected fetal distress and adverse outcome was assessed using univariable and multivariable logistic regression analyses. Main outcome measuresInterventions for suspected fetal distress and adverse outcome (defined as presence of metabolic acidosis (i.e. umbilical cord pH <7.05 and base deficit in extracellular fluid >12mmol), umbilical cord pH <7.00, 5-min Apgar score <7, admittance to neonatal intensive care unit or perinatal death). ResultsAlthough the presence of biphasic events of the FECG was associated with more interventions for fetal distress and an increased risk of adverse outcome compared with cases with no biphasic events, the presence of significant (i.e. intervention advised according to cardiotocography interpretation) biphasic events showed no independent association with interventions for fetal distress [odds ratio (OR) 1.71, 95% confidence interval (CI) 0.65-4.50] or adverse outcome (OR 1.96, 95% CI 0.74-5.24). ConclusionThe presence of significant biphasic events did not discriminate in the prediction of interventions for fetal distress or adverse outcome. Therefore, biphasic events in relation to ST-analysis monitoring during birth should be omitted if future studies confirm our findings. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Biphasic events, fetal electrocardiogram, neonatal outcome, ST-analysis
in
Acta Obstetricia et Gynecologica Scandinavica
volume
94
issue
2
pages
175 - 182
publisher
Wiley-Blackwell
external identifiers
  • wos:000348718800008
  • scopus:84921488445
ISSN
1600-0412
DOI
10.1111/aogs.12548
language
English
LU publication?
yes
id
a3311040-32b5-4d3d-b274-27158e3222b1 (old id 5187058)
date added to LUP
2015-04-01 07:32:32
date last changed
2017-01-01 05:29:24
@article{a3311040-32b5-4d3d-b274-27158e3222b1,
  abstract     = {ObjectiveTo study the predictive value of biphasic ST-events for interventions for suspected fetal distress and adverse neonatal outcome, when using ST-analysis of the fetal electrocardiogram (FECG) for intrapartum fetal monitoring. DesignProspective cohort study. SettingThree academic hospitals in Sweden. PopulationWomen in labor with a high-risk singleton fetus in cephalic position beyond 36weeks of gestation. MethodsIn women in labor who were monitored with conventional cardiotocography, ST-waveform analysis was recorded and concealed. Traces with biphasic ST-events of the FECG (index) were compared with traces without biphasic events of the FECG. The ability of biphasic events to predict interventions for suspected fetal distress and adverse outcome was assessed using univariable and multivariable logistic regression analyses. Main outcome measuresInterventions for suspected fetal distress and adverse outcome (defined as presence of metabolic acidosis (i.e. umbilical cord pH &lt;7.05 and base deficit in extracellular fluid &gt;12mmol), umbilical cord pH &lt;7.00, 5-min Apgar score &lt;7, admittance to neonatal intensive care unit or perinatal death). ResultsAlthough the presence of biphasic events of the FECG was associated with more interventions for fetal distress and an increased risk of adverse outcome compared with cases with no biphasic events, the presence of significant (i.e. intervention advised according to cardiotocography interpretation) biphasic events showed no independent association with interventions for fetal distress [odds ratio (OR) 1.71, 95% confidence interval (CI) 0.65-4.50] or adverse outcome (OR 1.96, 95% CI 0.74-5.24). ConclusionThe presence of significant biphasic events did not discriminate in the prediction of interventions for fetal distress or adverse outcome. Therefore, biphasic events in relation to ST-analysis monitoring during birth should be omitted if future studies confirm our findings.},
  author       = {Becker, Jeroen H. and Krikhaar, Anniek and Schuit, Ewoud and Martendal, Annika and Marsal, Karel and Kwee, Anneke and Visser, Gerard H. A. and Amer-Wahlin, Isis},
  issn         = {1600-0412},
  keyword      = {Biphasic events,fetal electrocardiogram,neonatal outcome,ST-analysis},
  language     = {eng},
  number       = {2},
  pages        = {175--182},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Obstetricia et Gynecologica Scandinavica},
  title        = {The added predictive value of biphasic events in ST analysis of the fetal electrocardiogram for intrapartumfetal monitoring},
  url          = {http://dx.doi.org/10.1111/aogs.12548},
  volume       = {94},
  year         = {2015},
}