A C TA Obstetricia et Gynecologica
AOGS M A I N R E SE A RC H A R TI C LE
The added predictive value of biphasic events in ST analysis of the fetal electrocardiogram for intrapartum fetal monitoring JEROEN H. BECKER1, ANNIEK KRIKHAAR2, EWOUD SCHUIT3, ANNIKA M ARTENDAL4, KAREL 5 2 2 MARSAL , ANNEKE KWEE , GERARD H. A. VISSER & ISIS AMER-WAHLIN6 1
Department of Obstetrics and Gynecology, Zuwe Hofpoort Hospital, Woerden, 2Department of Obstetrics and Gynecology, University Medical Center Utrecht, 3Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands, 4Neoventa Medical, Mo€lndal, 5Department of Obstetrics and Gynecology, Lund University, Lund, and 6Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden
Key words Biphasic events, fetal electrocardiogram, neonatal outcome, ST-analysis Correspondence Jeroen H. Becker, Van Alphenplein 9, 3581 JE Utrecht, the Netherlands. E-mail: [email protected] Conflict of interest Isis Amer-W ahlin has worked as a part time consultant for Neoventa Medical AB until January 2012. Annika M artendal currently works as a product manager at Neoventa Medical AB. Please cite this article as: Becker JH, Krikhaar A, Schuit E, M artendal A, Mars al K, Kwee A, et al. The added predictive value of biphasic events in ST analysis of the fetal electrocardiogram for intrapartum fetal monitoring. Acta Obstet Gynecol Scand 2015; 94: 175–182. Received: 21 January 2014 Accepted: 20 November 2014 DOI: 10.1111/aogs.12548
Abstract Objective. To study the predictive value of biphasic ST-events for interventions for suspected fetal distress and adverse neonatal outcome, when using ST-analysis of the fetal electrocardiogram (FECG) for intrapartum fetal monitoring. Design. Prospective cohort study. Setting. Three academic hospitals in Sweden. Population. Women in labor with a high-risk singleton fetus in cephalic position beyond 36 weeks of gestation. Methods. In women in labor who were monitored with conventional cardiotocography, ST-waveform analysis was recorded and concealed. Traces with biphasic ST-events of the FECG (index) were compared with traces without biphasic events of the FECG. The ability of biphasic events to predict interventions for suspected fetal distress and adverse outcome was assessed using univariable and multivariable logistic regression analyses. Main outcome measures. Interventions for suspected fetal distress and adverse outcome (defined as presence of metabolic acidosis (i.e. umbilical cord pH 12 mmol), umbilical cord pH
AOGS M A I N R E SE A RC H A R TI C LE
The added predictive value of biphasic events in ST analysis of the fetal electrocardiogram for intrapartum fetal monitoring JEROEN H. BECKER1, ANNIEK KRIKHAAR2, EWOUD SCHUIT3, ANNIKA M ARTENDAL4, KAREL 5 2 2 MARSAL , ANNEKE KWEE , GERARD H. A. VISSER & ISIS AMER-WAHLIN6 1
Department of Obstetrics and Gynecology, Zuwe Hofpoort Hospital, Woerden, 2Department of Obstetrics and Gynecology, University Medical Center Utrecht, 3Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands, 4Neoventa Medical, Mo€lndal, 5Department of Obstetrics and Gynecology, Lund University, Lund, and 6Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden
Key words Biphasic events, fetal electrocardiogram, neonatal outcome, ST-analysis Correspondence Jeroen H. Becker, Van Alphenplein 9, 3581 JE Utrecht, the Netherlands. E-mail: [email protected] Conflict of interest Isis Amer-W ahlin has worked as a part time consultant for Neoventa Medical AB until January 2012. Annika M artendal currently works as a product manager at Neoventa Medical AB. Please cite this article as: Becker JH, Krikhaar A, Schuit E, M artendal A, Mars al K, Kwee A, et al. The added predictive value of biphasic events in ST analysis of the fetal electrocardiogram for intrapartum fetal monitoring. Acta Obstet Gynecol Scand 2015; 94: 175–182. Received: 21 January 2014 Accepted: 20 November 2014 DOI: 10.1111/aogs.12548
Abstract Objective. To study the predictive value of biphasic ST-events for interventions for suspected fetal distress and adverse neonatal outcome, when using ST-analysis of the fetal electrocardiogram (FECG) for intrapartum fetal monitoring. Design. Prospective cohort study. Setting. Three academic hospitals in Sweden. Population. Women in labor with a high-risk singleton fetus in cephalic position beyond 36 weeks of gestation. Methods. In women in labor who were monitored with conventional cardiotocography, ST-waveform analysis was recorded and concealed. Traces with biphasic ST-events of the FECG (index) were compared with traces without biphasic events of the FECG. The ability of biphasic events to predict interventions for suspected fetal distress and adverse outcome was assessed using univariable and multivariable logistic regression analyses. Main outcome measures. Interventions for suspected fetal distress and adverse outcome (defined as presence of metabolic acidosis (i.e. umbilical cord pH 12 mmol), umbilical cord pH
