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- Noren, Håkan, 1948, et al.
(författare)
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STAN in clinical practice--the outcome of 2 years of regular use in the city of Gothenburg
- 2006
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Ingår i: Am J Obstet Gynecol. ; 195:1, s. 7-15
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The purpose of this study was to monitor the introduction of the STAN-methodology (Noventa Medical, Moelndal, Sweden). STUDY DESIGN: This was a prospective observational study covering the total population of deliveries at term during 2 years. Four thousand eight hundred and thirty out of 14,687 term pregnancies were monitored using the STAN S 21 fetal heart monitor and the associated clinical guidelines. Cord artery metabolic acidosis, neonatal outcome, and rates of operative deliveries for fetal distress were assessed. RESULTS: The annual rate of STAN usage increased from 28.1% to 37.7% and was associated with a significant reduction in metabolic acidosis rate in the total population from 0.76% to 0.44% (P < .05). The compliance with the clinical guidelines increased in cases requiring intervention. The rates for moderate/severe hypoxic neonatal encephalopathy were consistently low, 0.55 and 0.68 per 1000 deliveries, respectively, and corresponding to previous findings. The rate of operative delivery did not change during the 2 years in the total population. CONCLUSION: Increasing STAN usage provided consistent improvements in fetal outcome equalling those noted in the Swedish randomized controlled trial (RCT) without increasing operative interventions for fetal distress.
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| 2. |
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| 3. |
- Luttkus, Andreas, et al.
(författare)
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Fetal scalp pH and ST analysis of the fetal ECG as an adjunct to CTG. A multi-center, observational study
- 2004
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Ingår i: J Perinat Med. ; 32:6, s. 486-94
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the relationships between scalp-pH and CTG plus ST waveform analysis of the fetal ECG (STAN) clinical guidelines as indicators of intrapartum hypoxia in term fetuses born with cord artery acidemia. STUDY DESIGN: Data from 6999 term deliveries monitored by the STAN (R) S 21 as part of an EU multi-center study on clinical implementation of the STAN methodology for intrapartum fetal surveillance were analyzed. We identified 911 cases where a scalp-pH was obtained, including 53 cases with cord artery acidemia (pH < 7.06). Lag times between ST events and scalp-pH and time to delivery were related to cord artery metabolic and respiratory acidosis and neonatal outcome. RESULTS: 43 fetuses were identified by CTG plus ST as being in need of intervention 31 (25-46) minutes before delivery (median, 95% Cl). In five, no indications were given and in another five there were inadequate data. Fifteen cases with metabolic acidosis required special neonatal care, all 14 cases adequately monitored on STAN had indications to intervene for 19 minutes or more. In 30 adequately recorded cases, fetal blood sampling (FBS) was obtained within the last hour of labor. In 22 cases, FBS was obtained 13 (7-24) minutes after STAN guidelines had indicated abnormality and in eight no ST changes had occurred at time of FBS. The corresponding FBS data were pH 7.10 (7.01-7.15) and pH 7.21 (7.08-7.31), respectively, P = 0.01. In cases of metabolic acidosis, scalp-pH fell 0.01 units per minute after a baseline T/QRS rise was recorded during the second stage of labor. Apart from one newborn that died at 2 h from E. Coli septicemia, none of the neonates were affected neurologically. CONCLUSION: Cardiotocography plus ST analysis provides accurate information about intrapartum hypoxia similar to that obtained by scalp-pH.
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| 5. |
- Olofsson, Per, et al.
(författare)
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Identifying newborns with umbilical cord blood metabolic acidosis by intrapartum cardiotography combined with fetal ECG ST analysis (STAN): comparison of the new and old FIGO systems to classify cardiotocograms
- 2020
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 33:3, s. 404-409
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The intrapartum cardiotocography (CTG) classification system by FIGO in 2015 (FIGO2015) was introduced to simplify CTG interpretation, but it is not harmonized with the fetal ECG ST analysis (STAN) algorithm from 2007 (STAN2007), which is based on the FIGO CTG system from 1987. The study aimed to determine time courses and sensitivity between the systems in classifying CTG + ST events to indicate metabolic acidosis at birth. Material and methods: Forty-four cases with umbilical cord artery metabolic acidosis were retrieved from a European multicenter database. CTG patterns and timing of the first occurring significant ST events were evaluated post hoc in consensus by an expert panel and sensitivity statistics were performed. Wilcoxon's matched-pairs signed-ranks test and McNemar's test were used with a two-tailed p < .05 regarded significant. Results: STAN2007 had a higher sensitivity (73 versus 43%, p = .0002) and alarmed for metabolic acidosis in mean 34 min earlier than the FIGO2015 system did (p = .002). In every fourth case, the time difference was >= 20 min. Conclusions: In this simulation study, surveillance with STAN2007 combined with fetal ECG ST analysis had a significantly higher sensitivity and would have alarmed for metabolic acidosis significantly earlier than the new FIGO system would have.
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| 7. |
- Hafström, Maria, 1962, et al.
(författare)
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Developmental Outcome at 6.5 Years After Acidosis in Term Newborns : A Population-Based Study
- 2012
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Ingår i: Pediatrics. - : American Academy of Pediatrics. - 0031-4005 .- 1098-4275. ; 129:6, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Infants who develop encephalopathy after perinatal asphyxia have an increased risk of death and adverse neurologic outcome. Conflicting results exist concerning outcome in healthy infants with metabolic acidosis at birth. The aim of the current study was to evaluate whether metabolic acidosis at birth in term infants who appear healthy is associated with long-term developmental abnormalities. METHODS: From a population-based cohort (14 687 deliveries), 78 infants were prospectively identified as having metabolic acidosis (umbilical artery pH , 7.05 and base deficit in the extracellular fluid .12.0 mmol/L). Two matched controls per case were selected. The child health and school health care records were scrutinized for developmental abnormalities. RESULTS: Outcome measures at 6.5 years of age for 227 of 234 children (97%) were obtained. No differences were found concerning neurologic or behavioral problems in need of referral action or neurodevelopmental diagnosis in comparison of control children with acidotic children who had appeared healthy at birth, ie, had not required special neonatal care or had no signs of encephalopathy. CONCLUSIONS: Infants born with cord metabolic acidosis and who appear well do not have an increased risk for neurologic or behavioral problems in need of referral actions or special teaching approaches at the age of 6.5 years. Pediatrics 2012;129:1–7
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| 8. |
- Kro, G A B, et al.
(författare)
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A new tool for the validation of umbilical cord acid-base data.
- 2010
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 117:12, s. 1544-52
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Tidskriftsartikel (refereegranskat)abstract
- To identify the distribution of carbon dioxide tension (pCO(2) ) relative to pH in validated umbilical cord acid-base data.
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| 9. |
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| 10. |
- Noren, Håkan, 1948
(författare)
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ST analysis of the fetal ECG as an adjunct to fetal heart rate monitoring in labour-a clinical validation
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The ability to make an accurate assessment of fetal well-being during labour is a great challenge. Animal and human studies have shown that fetal hypoxemia during labour can alter the shape of the fetal electrocardiogram (FECG) waveform, notable elevation of the T-wave and depression of the ST segment. A new medical device (STAN, Neoventa Medical, Mölndal, Sweden) has been developed to monitor the FECG during labour as an adjunct to continuous electronic FHR monitoring (CTG+ST analysis). Before a more general clinical use the technique has been the object of three randomised trials. The present thesis concerns the implementation of this new technique into clinical practice. At Sahlgren’s hospital, Göteborg, Sweden, 4830 out of 14687 (32.9%) term deliveries were monitored between October 2000 and September 2002. While the number of monitored cases increased from 28.1% in the first year to 37.7% during the second year, the frequency of metabolic acidosis (pH <7.05 and BDecf >12mmol/L) decreased from 0.76% to 0.44% in all patients and from 1.12% to 0.56% in the CTG+ST monitored group assessed to be in need of close surveillance. The number of operative deliveries was unaltered (Paper I). In a retrospective study at Varberg district hospital labour ward, covering the total population of deliveries during 2004 and 2005, 59% of the deliveries (1875/3193) were monitored with CTG+ST. The metabolic acidosis rate was 0.5%. Crash Caesarean sections (CS) were significantly reduced from 1.5% in the conventionally monitored (CTG) group to 0.3% in the CTG+ST group (Paper II). It was concluded that the frequency of metabolic acidosis in this large number of deliveries from Göteborg and Varberg is the same as noted in the CTG+ST group in a Swedish randomised trial on CTG+ST analysis. Cases originating from a European Union commission supported multi centre study where CTG+ST had been used together with fetal blood sampling (FBS) were analysed. Of the 911 cases, 53 had cord artery pH<7.06 and 44 had cord artery pH 7.06 -7.09. These cases were analysed together with 97 control cases. CTG+ST clinical guidelines identified all adequately monitored cases with metabolic acidosis requiring special neonatal care. These cases were identified at least 19 minutes prior to delivery. In 22 cases, FBS was obtained 13 (7-24) minutes after CTG+ST guidelines had indicated abnormality and in eight no ST changes had occurred at time of FBS. The corresponding FBS data were pH 7.10 (7.01 – 7.15) and pH 7.21 (7.08 – 7.31), respectively, p=0.01. In cases of metabolic acidosis, scalp-pH fell 0.01 units per minute after a ST change rise had been recorded during second stage of labour. In 43 out of 53 cases with cord artery pH <7.06 CTG + ST indicated intervention. In five cases no ST data existed and in the rest of the cases there were no ST indications. One of these newborn had metabolic acidosis but was clinically unaffected (Paper III and IV). The time factor, i.e. the time between onset of significant ST events and delivery can be illustrated by the observation that of those with CTG+ST events recorded within 16 minutes of delivery, 61% had cord artery pH ≥7.20. The corresponding figure for cases where CTG+ST indications occurred more than 16 minutes before delivery was 19% (OR 6.66, 2.29 – 19.86, p<0.001). In conclusion, these data indicate that ST analysis of the FECG identifies a term fetus exposed to hypoxia during labour in a reliable way. FBS has a role in fetal monitoring, e.g. when a CTG+ST recording starts late in labour with abnormal CTG. Keywords: fetal ECG, ST analysis, electronic fetal monitoring, cardiotocography, fetal blood sampling, metabolic acidosis.
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