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- Schuit, Ewoud, et al.
(författare)
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Effectiveness of electronic fetal monitoring with additional ST analysis in vertex singleton pregnancies at > 36 weeks of gestation: an individual participant data metaanalysis
- 2013
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 1097-6868 .- 0002-9378. ; 208:3, s. 1-187
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The purpose of this study was to assess the effectiveness of electronic fetal monitoring (EFM) alone and with additional ST analysis (EFM + ST) in laboring women with a singleton term pregnancy that is in cephalic presentation in the prevention of metabolic acidosis by the application of individual patient data metaanalysis. STUDY DESIGN: We conducted an individual patient data metaanalysis using data from 4 randomized trials, which enabled us to account for missing data and investigate relevant subgroups. The primary outcome was metabolic acidosis, which was defined as an umbilical cord-artery pH <7.05 and a base deficit that had been calculated in the extra cellular fluid compartment >12 mmol/L. We performed 8 explanatory subgroup analyses for 8 different endpoints. RESULTS: We analyzed data from 12,987 women and their newborn infants. Metabolic acidosis was present in 57 women (0.9%) in the EFM + ST group and 73 women (1.1%) in the EFM alone group (relative risk [RR], 0.76; 95% CI, 0.53-1.10). Compared with EFM alone, the use of EFM + ST resulted in a reduction in the frequency of instrumental vaginal deliveries (RR, 0.90; 95% CI, 0.83-0.99) and fetal blood samples (RR, 0.49; 95% CI, 0.44-0.55). Cesarean delivery rates were comparable between both groups (RR, 0.99; 95% CI, 0.91-1.09). Subgroup analyses showed that EFM + ST resulted in fewer admissions to a neonatal intensive care unit for women with a duration of pregnancy of >41 weeks (RR, 0.61; 95% CI, 0.39-0.95). CONCLUSION: EFM + ST does not reduce the risk of metabolic acidosis, but it does reduce the need for instrumental vaginal deliveries and fetal blood sampling.
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| 2. |
- Simic, Marija, et al.
(författare)
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Survival and neonatal morbidity among extremely preterm born infants in relation to gestational age based on the last menstrual period or ultrasonographic examination
- 2014
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Ingår i: Journal of Perinatal Medicine. - : Walter de Gruyter GmbH. - 1619-3997 .- 0300-5577. ; 42:2, s. 247-253
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to investigate the potential impact of gestational age (GA) estimation on the basis of the last menstrual period (LMP) in comparison with GA based on ultrasound examination on rates of survival and neonatal morbidity among extremely preterm infants. Methods: The Swedish national registry of infants born extremely preterm (Extremely Preterm Infants in Sweden Study), including infants born before 27 weeks of gestation, was used to identify 645 infants with available information. Incidences of stillbirth, survival, small for GA (SGA), and major neonatal morbidity were calculated in relationship to the GA estimated by each of the approaches. Results: Pregnancies, in general, appeared to be longer when GA was estimated by LMP than by ultrasound (17.2% of the pregnancies were longer than 27 weeks). The incidences of stillbirth, neonatal death, and major neonatal morbidity in relationship to GA were similar for both groups. The risks for SGA were elevated when GA according to ultrasound examination was at least 7 days shorter than GA based on the LMP. Conclusions: In our cohort of infants born extremely preterm, estimation of GA on the basis of LMP indicated a longer pregnancy than estimated by ultrasound but did not influence the incidences of neonatal survival and morbidity.
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| 3. |
- 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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