[Routine use of ST-segment of fetal electrocardiogram for monitoring labor. A year's experience (preliminary results)].
OBJECTIVE
Two randomized trials found that monitoring labor by analyzing the fetal electrocardiogram (STAN) appears to offer better sensitivity and specificity in screening for metabolic acidosis than cardiotocography (CTG) does. We report here the results of a descriptive study of 173 cases between 1 June 2001 and 31 May 2002, the objectives of which were twofold: to determine the number of possible false negatives (defined by neonatal metabolic acidosis with a pH less than 7.05 and base deficit (BD) greater than 12 mmol/l, in the absence of a STAN decisions event more than 30 min before birth), and to assess whether STAN indicated the need for operative intervention too late in cases of fetal distress.


METHODS
Our study was conducted on an at-risk population with CTG changes. STAN was used with a scalp electrode to monitor labor according to a protocol based upon the FIGO CTG classification and the clinical instructions used in the Swedish trial. Accordingly, we compared two groups: in group 1, a STAN decision event required a rapid conclusion to labor, while in group 2, the absence of any STAN decision event meant that labor continued, despite the changes in the tracing.


RESULTS
We found seven cases with a neonatal pH less than 7.05, but only one may involve a false negative by this method. The mean arterial pH and the number of fetuses born with an arterial pH less than 7.10 did not differ significantly between the two groups, nor were there any significant differences in the mean BD at birth, or the number of children with a BD greater than 12 mmol/l.


CONCLUSIONS
The results appear to indicate that use of STAN with the usual CTG enables an appropriate response to cases of fetal distress, but it remains difficult to determine the real benefits that can be expected from this method in France. Longer assessment in our population is required before we can assess its actual advantages.
Haberstich
R
R
Département de gynécologie-obstétrique, CHU de Hautepierre, avenue Molière, 67098 Strasbourg, France. renaud.haberstich@wanadoo.fr
Vayssière
C
C
David
E
E
Sebahoun
V
V
Schmitt
B
B
Langer
B
B
Nisand
I
I
D000138:Acidosis / Q000175:diagnosis*; D015148:Cardiotocography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D005188:False Negative Reactions; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis; D005323:Fetal Monitoring / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D011247:Pregnancy; D012680:Sensitivity and Specificity