title: Effectiveness of electronic fetal monitoring with additional ST analysis in vertex singleton pregnancies at >36 weeks of gestation: an individual participant data metaanalysis.
abstract: OBJECTIVE
  The purpose of this study was to assess the effectiveness of electronic fetal monitoring (EFM) alone and with additional ST analysis (EFM + ST) in laboring women with a singleton term pregnancy that is in cephalic presentation in the prevention of metabolic acidosis by the application of individual patient data metaanalysis.
  
  
  METHODS
  We conducted an individual patient data metaanalysis using data from 4 randomized trials, which enabled us to account for missing data and investigate relevant subgroups. The primary outcome was metabolic acidosis, which was defined as an umbilical cord-artery pH <7.05 and a base deficit that had been calculated in the extra cellular fluid compartment >12 mmol/L. We performed 8 explanatory subgroup analyses for 8 different endpoints.
  
  
  RESULTS
  We analyzed data from 12,987 women and their newborn infants. Metabolic acidosis was present in 57 women (0.9%) in the EFM + ST group and 73 women (1.1%) in the EFM alone group (relative risk [RR], 0.76; 95% CI, 0.53-1.10). Compared with EFM alone, the use of EFM + ST resulted in a reduction in the frequency of instrumental vaginal deliveries (RR, 0.90; 95% CI, 0.83-0.99) and fetal blood samples (RR, 0.49; 95% CI, 0.44-0.55). Cesarean delivery rates were comparable between both groups (RR, 0.99; 95% CI, 0.91-1.09). Subgroup analyses showed that EFM + ST resulted in fewer admissions to a neonatal intensive care unit for women with a duration of pregnancy of >41 weeks (RR, 0.61; 95% CI, 0.39-0.95).
  
  
  CONCLUSIONS
  EFM + ST does not reduce the risk of metabolic acidosis, but it does reduce the need for instrumental vaginal deliveries and fetal blood sampling.
authors: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands. E.Schuit@umcutrecht.nl
authors: Ewoud
authors: E
authors: Schuit
authors: Isis
authors: I
authors: Amer-Wahlin
authors: Kati
authors: K
authors: Ojala
authors: Christophe
authors: C
authors: Vayssière
authors: Michelle E M H
authors: ME
authors: Westerhuis
authors: Karel
authors: K
authors: Maršál
authors: Aydin
authors: A
authors: Tekay
authors: George R
authors: GR
authors: Saade
authors: Gerard H A
authors: GH
authors: Visser
authors: Rolf H H
authors: RH
authors: Groenwold
authors: Karel G M
authors: KG
authors: Moons
authors: Ben Willem J
authors: BW
authors: Mol
authors: Anneke
authors: A
authors: Kwee
mesh_terms: D000138:Acidosis / Q000175:diagnosis; D000328:Adult; D015148:Cardiotocography / Q000379:methods; D036861:Delivery, Obstetric; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D011247:Pregnancy; D011263:Pregnancy Trimester, Third