ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta-analysis of randomized trials

Abstract

Introduction: ST waveform analysis (STAN) was introduced as an adjunct to cardioto- cography (CTG) to improve neonatal and maternal outcomes. The aim of the present study was to quantify the efficacy of STAN vs CTG and assess the quality of the evi- dence using GRADE. Material and methods: We performed systematic literature searches to identify rand- omized controlled trials and assessed included studies for risk of bias. We performed meta-analyses, calculating pooled risk ratio (RR) or Peto odds ratio (OR). We also per- formed post hoc trial sequential analyses for selected outcomes to assess the risk of false-positive results and the need for additional studies. Results: Nine randomized controlled trials including 28 729 women were included in the meta-analysis. There were no differences between the groups in operative deliv - eries for fetal distress (10.9 vs 11.1%; RR 0.96; 95% confidence interval [CI] 0.82–1.11). STAN was associated with a significantly lower rate of metabolic acidosis (0.45% vs 0.68%; Peto OR 0.66; 95% CI 0.48–0.90). Accordingly, 441 women need to be moni- tored with STAN instead of CTG alone to prevent one case of metabolic acidosis. Women allocated to STAN had a reduced risk of fetal blood sampling compared with women allocated to conventional CTG monitoring (12.5% vs 19.6%; RR 0.62; 95% CI 0.49–0.80). The quality of the evidence was high to moderate. Conclusions: Absolute effects of STAN were minor and the clinical significance of the observed reduction in metabolic acidosis is questioned. There is insufficient evidence to state that STAN as an adjunct to CTG leads to important clinical benefits compared with CTG alone.