title: Improved intrapartum surveillance with PR interval analysis of the fetal electrocardiogram: a randomized trial showing a reduction in fetal blood sampling.
abstract: OBJECTIVE
  Our goal was to test the hypothesis that the addition of fetal electrocardiogram time-interval analysis to conventional electronic fetal monitoring would significantly reduce the number of cases requiring fetal scalp blood sampling without an increase in adverse outcome.
  
  
  METHODS
  A randomized prospective trial was performed in 214 women with high-risk labor.
  
  
  RESULTS
  There was a significant reduction in the number of cases that had fetal blood sampling performed in the fetal electrocardiogram plus electronic fetal monitoring group (risk ratio for electronic fetal monitoring alone 3.53; p < 0.01, 95% confidence interval 1.39 to 8.95). The fetal blood samplings performed in the electronic fetal monitoring alone group were less likely to be abnormal (pH < 7.25, base excess < -8.0) than those performed in the fetal electrocardiogram plus electronic fetal monitoring group (risk ratio for electronic fetal monitoring alone 0.62, p = 0.05, 95% confidence interval 0.35 to 1.10). There was a trend of more infants with an arterial umbilical pH < 7.15 and a base excess less than -8.0 mmol/L at birth being unsuspected and more instrumental deliveries for presumed fetal distress being performed in the electronic fetal monitoring alone than in the fetal electrocardiogram plus electronic fetal monitoring group.
  
  
  CONCLUSIONS
  The addition of fetal electrocardiogram analysis to conventional electronic fetal monitoring during labor can reduce significantly the number of parturients undergoing fetal scalp blood sampling and can simultaneously increase its efficiency without an increase in adverse outcome.
authors.affiliation: Queen's Medical Centre, University of Nottingham, United Kingdom.
authors.forename: W J
authors.initials: WJ
authors.lastname: van Wijngaarden
authors.forename: D S
authors.initials: DS
authors.lastname: Sahota
authors.forename: D K
authors.initials: DK
authors.lastname: James
authors.forename: T
authors.initials: T
authors.lastname: Farrell
authors.forename: G J
authors.initials: GJ
authors.lastname: Mires
authors.forename: M
authors.initials: M
authors.lastname: Wilcox
authors.forename: A
authors.initials: A
authors.lastname: Chang
mesh_terms: D000138:Acidosis / Q000175:diagnosis; D001800:Blood Specimen Collection / Q000706:statistics & numerical data*; D004562:Electrocardiography; D005260:Female; D005312:Fetal Blood; D005315:Fetal Diseases / Q000175:diagnosis; D005323:Fetal Monitoring / Q000379:methods*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016017:Odds Ratio; D011247:Pregnancy; D011446:Prospective Studies