Document Detail

Fetal electrocardiogram (ECG) for fetal monitoring during labour.
MedLine Citation:
PMID:  22513897     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Hypoxaemia during labour can alter the shape of the fetal electrocardiogram (ECG) waveform, notably the relation of the PR to RR intervals, and elevation or depression of the ST segment. Technical systems have therefore been developed to monitor the fetal ECG during labour as an adjunct to continuous electronic fetal heart rate monitoring with the aim of improving fetal outcome and minimising unnecessary obstetric interference.
OBJECTIVES: To compare the effects of analysis of fetal ECG waveforms during labour with alternative methods of fetal monitoring.
SEARCH METHODS: The Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2012).
SELECTION CRITERIA: Randomised trials comparing fetal ECG waveform analysis with alternative methods of fetal monitoring during labour.
DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction were performed by one review author, without blinding.
MAIN RESULTS: Six trials (16,295 women) were included: five trials of ST waveform analysis (15,338 women) and one trial of PR interval analysis (957 women). In comparison to continuous electronic fetal heart rate monitoring alone, the use of adjunctive ST waveform analysis made no significant difference to primary outcomes: births by caesarean section (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.91 to 1.08), the number of babies with severe metabolic acidosis at birth (cord arterial pH less than 7.05 and base deficit greater than 12 mmol/L) (RR 0.78, 95% CI 0.44 to 1.37, data from 14,574 babies), or babies with neonatal encephalopathy (RR 0.54, 95% CI 0.24 to 1.25). There were, however, on average fewer fetal scalp samples taken during labour (RR 0.61, 95% CI 0.41 to 0.91) although the findings were heterogeneous; there were fewer operative vaginal deliveries (RR 0.90, 95% CI 0.81 to 0.98) and admissions to special care unit (RR 0.89, 95% CI 0.81 to 0.99); there was no statistically significant difference in the number of babies with low Apgar scores at five minutes or babies requiring neonatal intubation. There was little evidence that monitoring by PR interval analysis conveyed any benefit.
AUTHORS' CONCLUSIONS: These findings provide some modest support for the use of fetal ST waveform analysis when a decision has been made to undertake continuous electronic fetal heart rate monitoring during labour. However, the advantages need to be considered along with the disadvantages of needing to use an internal scalp electrode, after membrane rupture, for ECG waveform recordings.
James P Neilson
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2012-04-18
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  4     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2012  
Date Detail:
Created Date:  2012-04-19     Completed Date:  2012-07-23     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD000116     Citation Subset:  IM    
Department of Women’s and Children’s Health, The University of Liverpool, Liverpool, UK.
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MeSH Terms
Cardiotocography / methods*
Cesarean Section
Electrocardiography / methods*
Heart Rate, Fetal / physiology*
Labor, Obstetric*
Randomized Controlled Trials as Topic
Uterine Contraction / physiology
Update In:
Cochrane Database Syst Rev. 2013;5:CD000116   [PMID:  23728630 ]
Update Of:
Cochrane Database Syst Rev. 2006;(3):CD000116   [PMID:  16855950 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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