title: Fetal monitoring with computerized ST analysis during labor: a systematic review and meta-analysis.
abstract: BACKGROUND
  Computerized ST analysis of fetal electrocardiography (ECG) combined with cardiotochography (CTG) has been introduced for intrapartum monitoring and is the prevailing method when ST analysis (STAN®) is used.
  
  
  OBJECTIVE
  To assess the evidence that computerized ST analysis during labor reduces the incidence of fetal metabolic acidosis, hypoxic ischemic encephalopathy, cesarean section, instrumental vaginal delivery or the number of instances where fetal scalp blood sampling is used as compared with CTG only.
  
  
  METHODS
  Search of PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL and CRD databases.
  
  
  METHODS
  CTG only compared with CTG + computerized ST analysis.
  
  
  METHODS
  Studies were assessed using pre-designed templates. Meta-analyses of included randomized controlled trials were performed using a random effects model.
  
  
  RESULTS
  Risk ratio for cord metabolic acidosis with STAN® was 0.96 [95% confidence interval (CI) 0.49-1.88]. Risk ratio for cesarean sections or instrumental vaginal deliveries for fetal distress was 0.93 (95%CI 0.80-1.08) and for fetal scalp blood sampling 0.55 (95%CI 0.40-0.76). Encephalopathy cases were not assessed due to their low incidence.
  
  
  CONCLUSIONS
  There is not enough scientific evidence to conclude that computerized ST analysis reduces the incidence of metabolic acidosis. Cesarean sections and instrumental vaginal deliveries due to fetal distress or other indications are the same, regardless of method, but STAN® reduces the number of instances which require scalp blood sampling.
authors.affiliation: Karolinska Institute, Stockholm, Sweden.
authors.forename: Anette
authors.initials: A
authors.lastname: Salmelin
authors.forename: Ingela
authors.initials: I
authors.lastname: Wiklund
authors.forename: Roger
authors.initials: R
authors.lastname: Bottinga
authors.forename: Bengt
authors.initials: B
authors.lastname: Brorsson
authors.forename: Gunvor
authors.initials: G
authors.lastname: Ekman-Ordeberg
authors.forename: Eva Eneroth
authors.initials: EE
authors.lastname: Grimfors
authors.forename: Ulf
authors.initials: U
authors.lastname: Hanson
authors.forename: May
authors.initials: M
authors.lastname: Blom
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Persson
mesh_terms: D015148:Cardiotocography / Q000379:methods*; D036861:Delivery, Obstetric; D005260:Female; D005323:Fetal Monitoring / Q000379:methods; D006801:Humans; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic