title: Electrocardiogram ST Analysis During Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  To compare the effectiveness of cardiotocography plus ST analysis with cardiotocography alone during labor.
  
  
  METHODS
  Randomized controlled trials were identified by searching electronic databases.
  
  
  METHODS
  We included all randomized controlled trials comparing intrapartum fetal monitoring with cardiotocography plus ST analysis with cardiotocography alone. The primary outcome (ie, perinatal composite outcome) was a composite of intrapartum fetal death, neonatal death, Apgar score 3 or less at 5 minutes, neonatal seizure, metabolic acidosis (defined as umbilical arterial pH 7.05 or less, and extracellular fluid base deficit 12 mmol/L or greater), intubation for ventilation at delivery, or neonatal encephalopathy.
  
  
  RESULTS
  Six randomized controlled trials, which included 26,529 laboring singletons with cephalic presentation at term, were analyzed. Compared with women who were randomized to cardiotocography, those who were randomized to ST analysis and cardiotocography had a similar incidence of perinatal composite outcome (1.5% compared with 1.6%; relative risk [RR] 0.90, 95% confidence interval [CI] 0.74-1.10; five studies), neonatal metabolic acidosis (0.5% compared with 0.7%; RR 0.74, 95% CI 0.54-1.02; five studies), admission to the neonatal intensive care unit (5.4% compared with 5.5%; RR 0.99, 95% CI 0.90-1.10; six studies), perinatal death (0.1% compared with 0.1%; RR 1.71, 95% CI 0.67-4.33; six studies), neonatal encephalopathy (0.1% compared with 0.2%; RR 0.62, 95% CI 0.25-1.52; six studies), cesarean delivery (13.8% compared with 14.0%; RR 0.96, 95% CI 0.85-1.08; six studies), and operative delivery (either cesarean or operative vaginal delivery) (23.9% compared with 25.1%; RR 0.93, 95% CI 0.86-1.01; six studies).
  
  
  CONCLUSIONS
  The use of ST analysis during labor as an adjunct to the standard cardiotocography does not improve perinatal outcomes or decrease cesarean delivery.
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, and the Department of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Padua, Italy; the Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, California; the Medical Management Center, Department of Learning Informatics Management and Ethics and Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Saccone
authors.forename: Ewoud
authors.initials: E
authors.lastname: Schuit
authors.forename: Isis
authors.initials: I
authors.lastname: Amer-Wåhlin
authors.forename: Serena
authors.initials: S
authors.lastname: Xodo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D000138:Acidosis / Q000453:epidemiology; D001034:Apgar Score; D001927:Brain Diseases / Q000453:epidemiology; D015148:Cardiotocography; D002585:Cesarean Section / Q000706:statistics & numerical data; D004562:Electrocardiography; D005260:Female; D005313:Fetal Death; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D007743:Labor, Obstetric / Q000502:physiology*; D066087:Perinatal Death; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012640:Seizures / Q000453:epidemiology