title: A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part II: the meta-analyses.
abstract: We appraised the methodology, execution and quality of the five published meta-analyses that are based on the five randomized controlled trials which compared cardiotocography (CTG)+ST analysis to cardiotocography. The meta-analyses contained errors, either created de novo in handling of original data or from a failure to recognize essential differences among the randomized controlled trials, particularly in their inclusion criteria and outcome parameters. No meta-analysis contained complete and relevant data from all five randomized controlled trials. We believe that one randomized controlled trial excluded in two of the meta-analyses should have been included, whereas one randomized controlled trial that was included in all meta-analyses, should have been excluded. After correction of the uncovered errors and exclusion of the randomized controlled trial that we deemed inappropriate, our new meta-analysis showed that CTG+ST monitoring significantly reduces the fetal scalp blood sampling usage (risk ratio 0.64; 95% confidence interval 0.47-0.88), total operative delivery rate (0.93; 0.88-0.99) and metabolic acidosis rate (0.61; 0.41-0.91).
authors.affiliation: Department of Obstetrics and Gynecology, Institution of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Olofsson
authors.forename: Diogo
authors.initials: D
authors.lastname: Ayres-de-Campos
authors.forename: Jörg
authors.initials: J
authors.lastname: Kessler
authors.forename: Britta
authors.initials: B
authors.lastname: Tendal
authors.forename: Branka M
authors.initials: BM
authors.lastname: Yli
authors.forename: Lawrence
authors.initials: L
authors.lastname: Devoe
mesh_terms: D000138:Acidosis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D015148:Cardiotocography; D036861:Delivery, Obstetric; D004562:Electrocardiography; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D007743:Labor, Obstetric / Q000502:physiology; D015201:Meta-Analysis as Topic; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012107:Research Design
keywords: Cardiotocography; ST analysis; fetal surveillance; meta-analysis; metabolic acidosis; randomized controlled trial