title: Fetal blood sampling in addition to intrapartum ST-analysis of the fetal electrocardiogram: evaluation of the recommendations in the Dutch STAN® trial.
abstract: OBJECTIVE
  To evaluate the recommendations for additional fetal blood sampling (FBS) when using ST-analysis of the fetal electrocardiogram.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Three academic and six non-academic teaching hospitals in the Netherlands.
  
  
  METHODS
  Labouring women with a high-risk singleton pregnancy in cephalic position beyond 36 weeks of gestation.
  
  
  METHODS
  In labouring women allocated to the STAN® arm of a previously published randomised controlled trial who underwent one or more FBS during delivery, we assessed whether FBS was performed according to the trial protocol and how fetal acidosis, defined as an FBS pH < 7.20, was related to ST-waveform analysis.
  
  
  METHODS
  The number of FBS showing fetal acidosis, related to the different STAN® criteria where additional FBS is recommended.
  
  
  RESULTS
  Among 2827 women monitored with STAN®, 297 underwent FBS, of whom 171 (57.6%) were performed according to the predefined criteria and 126 were performed in absence of these criteria. In the first group, rates of fetal acidosis (pH < 7.20) were two of 18, none of nine, 12 of 111 and three of 33 when FBS was taken for abnormal cardiotocogram (CTG) at the start, intermediary CTG at the start, abnormal CTG >60 minutes, and poor electrocardiogram quality, respectively. When the predefined criteria were not met and ST-analysis showed no ST-events, only two incidents of fetal acidosis were seen.
  
  
  CONCLUSIONS
  The performance of FBS is valuable in the advised STAN® criteria. When these criteria are not met, performance of FBS does not seem helpful in the detection of fetal acidosis.
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands. j.h.becker@umcutrecht.nl
authors.forename: J H
authors.initials: JH
authors.lastname: Becker
authors.forename: M E M H
authors.initials: ME
authors.lastname: Westerhuis
authors.forename: K
authors.initials: K
authors.lastname: Sterrenburg
authors.forename: E S A
authors.initials: ES
authors.lastname: van den Akker
authors.forename: E
authors.initials: E
authors.lastname: van Beek
authors.forename: A C
authors.initials: AC
authors.lastname: Bolte
authors.forename: T J H M
authors.initials: TJ
authors.lastname: van Dessel
authors.forename: A P
authors.initials: AP
authors.lastname: Drogtrop
authors.forename: H P
authors.initials: HP
authors.lastname: van Geijn
authors.forename: G C M
authors.initials: GC
authors.lastname: Graziosi
authors.forename: J M M
authors.initials: JM
authors.lastname: van Lith
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.forename: K G M
authors.initials: KG
authors.lastname: Moons
authors.forename: J G
authors.initials: JG
authors.lastname: Nijhuis
authors.forename: S G
authors.initials: SG
authors.lastname: Oei
authors.forename: H P
authors.initials: HP
authors.lastname: Oosterbaan
authors.forename: M M
authors.initials: MM
authors.lastname: Porath
authors.forename: R J P
authors.initials: RJ
authors.lastname: Rijnders
authors.forename: N W E
authors.initials: NW
authors.lastname: Schuitemaker
authors.forename: L D E
authors.initials: LD
authors.lastname: Wijnberger
authors.forename: C
authors.initials: C
authors.lastname: Willekes
authors.forename: G H A
authors.initials: GH
authors.lastname: Visser
authors.forename: A
authors.initials: A
authors.lastname: Kwee
mesh_terms: D000138:Acidosis / Q000175:diagnosis*; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D005315:Fetal Diseases / Q000175:diagnosis*; D005318:Fetal Heart / Q000502:physiology*; D005323:Fetal Monitoring / Q000379:methods*; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D011446:Prospective Studies