Effectiveness of electronic fetal monitoring with additional ST analysis in vertex singleton pregnancies at >36 weeks of gestation: An individual participant data metaanalysis

Ewoud Schuit, Isis Amer-Wahlin, Kati Ojala, Christophe Vayssière, Michelle E.M.H. Westerhuis, Karel Maršál, Aydin Tekay, George R. Saade, Gerard H.A. Visser, Rolf H.H. Groenwold, Karel G.M. Moons, Ben Willem J. Mol, Anneke Kwee

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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.

Original languageEnglish
Pages (from-to)187.e1-187.e13
JournalAmerican Journal of Obstetrics and Gynecology
Issue number3
Publication statusPublished or Issued - Mar 2013
Externally publishedYes


  • cardiotocography
  • fetal blood sampling
  • fetal electrocardiogram
  • instrumental vaginal delivery
  • metabolic acidosis

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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