A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part I: the randomized controlled trials.

• We reappraised the five randomized controlled trials (RCTs) that compared CTG+ST vs. CTG. The numbers enrolled ranged from 5681 (Dutch RCT) to 799 (French RCT). The Swedish RCT (N=5049) was the only trial adequately powered to show a difference in metabolic acidosis, and the Plymouth RCT (N=2434) was only powered to show a difference in operative delivery for fetal distress. There were considerable differences in study design: the French RCT used different inclusion criteria, and the Finnish RCT (N=1483) used a different metabolic acidosis definition. In the CTG+ST study arms, the larger Plymouth, Swedish and Dutch trials showed lower operative delivery and metabolic acidosis rates, while the smaller Finnish and French trials showed minor differences in operative delivery and higher metabolic acidosis rates. We conclude that the differences in outcomes are likely due to considerable differences in study design and size. This will enhance heterogeneity effects in any subsequent meta-analysis. This article is protected by copyright. All rights reserved.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

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