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Original Article

FHR patterns that become significant in connection with ST waveform changes and metabolic acidosis at birth

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Pages 3288-3293 | Received 18 Mar 2018, Accepted 04 Apr 2018, Published online: 18 Apr 2018
 

Abstract

Introduction: Recent developments have produced new CTG classification systems and the question is to what extent these may affect the model of FHR + ST interpretation? The two new systems (FIGO2015 and SSOG2017) classify FHR + ST events differently from the current CTG classification system used in the STAN interpretation algorithm (STAN2007).

Aim: Identify the predominant FHR patterns in connection with ST events in cases of cord artery metabolic acidosis missed by the different CTG classification systems. Indicate to what extent STAN clinical guidelines could be modified enhancing the sensitivity. Provide a pathophysiological rationale.

Material and methods: Forty-four cases with umbilical cord artery metabolic acidosis were retrieved from a European multicenter database. Significant FHR + ST events were evaluated post hoc in consensus by an expert panel.

Results: Eighteen cases were not identified as in need of intervention and regarded as negative in the sensitivity analysis. In 12 cases, ST changes occurred but the CTG was regarded as reassuring. Visual analysis of the FHR + ST tracings revealed specific FHR patterns:

Conclusion: These findings indicate FHR + ST analysis may be undertaken regardless of CTG classification system provided there is a more physiologically oriented approach to FHR assessment in connection with an ST event.

Ethics approval

The study was performed at maternity units in Berlin, Copenhagen, Derby, Gothenburg, Lyon, Oslo, Perugia, Plymouth, Turku and Utrecht, to evaluate the clinical implementation of STAN. Oral informed consent from enrolled women and ethical approvals were obtained in those maternity units where STAN was not part of standard care.

Acknowledgements

Neoventa Medical AB is acknowledged for providing the STAN Viewer computer software for offline analyses.

Disclosure statement

KGR is the founder of STAN and Neoventa Medical and holds a minute number of shares <1%. No current financial relationship. Håkan Norén and Ann Carlsson declare no conflicts of interest.

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