title: Cardiotocography plus ST analysis of fetal electrocardiogram compared with cardiotocography only for intrapartum monitoring: a randomized controlled trial.
abstract: OBJECTIVE
  To estimate the effectiveness of intrapartum fetal monitoring by cardiotocography plus ST analysis using a strict protocol for performance of fetal blood sampling.
  
  
  METHODS
  We performed a multicenter randomized trial among laboring women with a high-risk singleton pregnancy in cephalic presentation beyond 36 weeks of gestation. Participants were assigned to monitoring by cardiotocography with ST analysis (index) or cardiotocography only (control). Primary outcome was metabolic acidosis, defined as an umbilical cord artery pH below 7.05 combined with a base deficit calculated in the extracellular fluid compartment above 12 mmol/L. Secondary outcomes were metabolic acidosis in blood, operative deliveries, Apgar scores, neonatal admissions, and hypoxic-ischemic encephalopathy.
  
  
  RESULTS
  We randomly assigned 5,681 women to the two groups (2,832 index, 2,849 control). The fetal blood sampling rate was 10.6% in the index compared with 20.4% in the control group (relative risk 0.52; 95% [CI] 0.46-0.59). The primary outcome occurred 0.7% in the index compared with 1.1% in the control group (relative risk 0.70; 95% CI 0.38-1.28; number needed to treat 252). Using metabolic acidosis calculated in blood, these rates were 1.6% and 2.6%, respectively (relative risk 0.63; 95% CI 0.42-0.94; number needed to treat 100). The number of operative deliveries, low Apgar scores, neonatal admissions, and newborns with hypoxic-ischemic encephalopathy was comparable in both groups.
  
  
  CONCLUSIONS
  Intrapartum monitoring by cardiotocography combined with ST analysis does not significantly reduce the incidence of metabolic acidosis calculated in the extracellular fluid compartment. It does reduce the incidence of metabolic acidosis calculated in blood and the need for fetal blood sampling without affecting the Apgar score, neonatal admissions, hypoxic-ischemic encephalopathy, or operative deliveries.
  
  
  METHODS
  I.
authors.affiliation: From the University Medical Center Utrecht, Utrecht; Amsterdam Medical Center, Amsterdam; Free University Medical Center, Amsterdam; Maastricht University Medical Center, Maastricht; St Antonius Hospital, Nieuwegein; TweeSteden Hospital, Tilburg; Jeroen Bosch Hospital, Hertogenbosch; Diakonessenhuis, Utrecht; and Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Michelle E M H
authors.initials: MEMH
authors.lastname: Westerhuis
authors.forename: Gerard H A
authors.initials: GHA
authors.lastname: Visser
authors.forename: Karel G M
authors.initials: KGM
authors.lastname: Moons
authors.forename: Erik
authors.initials: E
authors.lastname: van Beek
authors.forename: Manon J
authors.initials: MJ
authors.lastname: Benders
authors.forename: Saskia M
authors.initials: SM
authors.lastname: Bijvoet
authors.forename: Hendrikus J H M
authors.initials: HJHM
authors.lastname: van Dessel
authors.forename: Addy P
authors.initials: AP
authors.lastname: Drogtrop
authors.forename: Herman P
authors.initials: HP
authors.lastname: van Geijn
authors.forename: Giuseppe C
authors.initials: GC
authors.lastname: Graziosi
authors.forename: Floris
authors.initials: F
authors.lastname: Groenendaal
authors.forename: Jan M M
authors.initials: JMM
authors.lastname: van Lith
authors.forename: Jan G
authors.initials: JG
authors.lastname: Nijhuis
authors.forename: S Guid
authors.initials: SG
authors.lastname: Oei
authors.forename: Herman P
authors.initials: HP
authors.lastname: Oosterbaan
authors.forename: Martina M
authors.initials: MM
authors.lastname: Porath
authors.forename: Robbert J P
authors.initials: RJP
authors.lastname: Rijnders
authors.forename: Nico W E
authors.initials: NWE
authors.lastname: Schuitemaker
authors.forename: Louisa M
authors.initials: LM
authors.lastname: Sopacua
authors.forename: Ingeborg
authors.initials: I
authors.lastname: van der Tweel
authors.forename: Lia D E
authors.initials: LDE
authors.lastname: Wijnberger
authors.forename: Christine
authors.initials: C
authors.lastname: Willekes
authors.forename: Nicolaas P A
authors.initials: NPA
authors.lastname: Zuithoff
authors.forename: Ben Willem J
authors.initials: BWJ
authors.lastname: Mol
authors.forename: Anneke
authors.initials: A
authors.lastname: Kwee
mesh_terms: D000138:Acidosis / Q000517:prevention & control*; D000328:Adult; D015148:Cardiotocography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000517:prevention & control; D007231:Infant, Newborn; D011247:Pregnancy