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| 2. |
- Olofsson, Per, et al.
(författare)
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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.
- 2014
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 93:6, s. 556-568
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Forskningsöversikt (refereegranskat)abstract
- 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.
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| 3. |
- Olofsson, Per, et al.
(författare)
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A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part II: the meta-analyses.
- 2014
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 93:6, s. 571-586
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Forskningsöversikt (refereegranskat)abstract
- We appraised the methodology, execution and quality of the five published meta-analyses that are based on the five randomized controlled trials (RCTs) which compared cardiotocography (CTG) +ST analysis to CTG. The meta-analyses contained errors, either created de novo in handling of original data, or from a failure to recognize essential differences among the RCTs, particularly in their inclusion criteria and outcome parameters. No meta-analysis contained complete and relevant data from all five RCTs. We believe that one RCT excluded in two of the meta-analyses should have been included, while one RCT that was included in all meta-analyses, should have been excluded. After correction of the uncovered errors and exclusion of the RCT 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). This article is protected by copyright. All rights reserved.
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- Yli, Branka M., et al.
(författare)
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Intrapartum cardiotocography (CTG) and ST-analysis of labor in diabetic patients
- 2011
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Ingår i: Journal of Perinatal Medicine. - 1619-3997. ; 39:4, s. 457-465
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To determine the prevalence and types of intrapartum cardiotocography (CTG) patterns and investigate their relationship to moderate acidemia in term fetuses of diabetic mothers. Also, to assess if the combination of fetal electrocardiogram (FECG) and those CTG patterns strengthens the association with moderate acidemia. Material and methods: The material for this study is obtained from the Swedish randomized control trial and the European Union ST-analysis trial. We developed an analytical model for CTG patterns based on the progress in CTG changes, in a longitudinal periodic manner. The model was then combined with information regarding changes in ST interval that indicate threatening asphyxia, and the findings were analyzed to determine correlation with the presence of moderate acidemia at birth. Results: This study involved data of 413 diabetic mothers. A preterminal CTG was more common in the diabetes mellitus (DM) group (6/70, 8.6%) than in the gestational diabetes (GD) group (3/307, 1.0%; P=0.003). For diabetic mothers (i.e., DM+GD) with a normal CTG at the start of monitoring, the presence of FECG data indicating asphyxia significantly increased the likelihood of an umbilical artery pH < 7.15 at birth wodds ratio (OR) = 3.65, 95% confidence interval (CI) = 1.33-10.05]. Among labors where the CTG was non-reassuring at the start of monitoring, no significant association was found between pH < 7.15 and indication to intervene according to FECG information (OR = 1.51, 95% CI = 0.33-7.0). Conclusions: A preterminal CTG is more common in the fetuses of DM than GD mothers during labor. When CTG was normal at the start of recording, the addition of FECG information gave a significant add on information to predict moderate acidemia.
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- Yli, Branka M, et al.
(författare)
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Intrapartum fetal ECG and diabetes
- 2008
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 21:4, s. 231-238
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Tidskriftsartikel (refereegranskat)abstract
- Aim. The objective of this study was to determine the prevalence and types of ST-segment changes of the fetal electrocardiogram (FECG) during labour in term fetuses born to mothers with diabetes mellitus (DM) or gestational diabetes. Methods. This was a retrospective case-control study involving populations from two multi centre trials: the Swedish Randomized Control Trial and the European Union ST-analysis (EU-STAN) trial. ST-segment changes were assessed in 104/309 cases and 207/468 controls from the Swedish and EU-STAN trials, respectively. Results. ST depression was present on the FECG in 22.1% of fetuses of mothers with DM compared to 12% of controls OR=2.6, 95% CI=1.4-4.7, p=0.002 after adjusting for trial, birth weight, and nulliparity. ST elevation was present in 47.1% of DM patients and 41.2% of controls (OR=1.4, 95% CI=0.9-2.3, p=0.18). Conclusion. ST depression on the FECG was significantly more prevalent in the fetuses of mothers with DM, probably not indicating hypoxia but an altered ability of the myocardium to respond to the stress of labour. Further studies into the mechanism of fetal compromise during diabetic labour, are required.
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- Yli, Branka M, et al.
(författare)
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Pathophysiology of foetal oxygenation and cell damage during labour.
- 2016
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Ingår i: Best practice & research. Clinical obstetrics & gynaecology. - : Elsevier BV. - 1532-1932 .- 1521-6934. ; 30, s. 9-21
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Tidskriftsartikel (refereegranskat)abstract
- A foetus exposed to oxygenation compromise is capable of several adaptive responses, which can be categorised into those affecting metabolism and those affecting oxygen transport. However, both the extent and duration of the impairment in oxygenation will have a bearing on these adaptive responses. Although intrapartum events may account for no more than one-third of cases with an adverse neurological outcome, they are important because they can be influenced successfully. This review describes the mechanisms underlying foetal hypoxia during labour, acid-base balance and gas exchange, and the current scientific understanding of the role of intrauterine asphyxia in the pathophysiology of neonatal encephalopathy and cerebral palsy. Although the mechanisms involved include similar initiating events, principally ischaemia and excitotoxicity, and similar final common pathways to cell death, there are certain unique maturational factors that influence the type and pattern of cellular injury.
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