BJOG - The Effectiveness Of STAN Technology In Intrapartum Fetal Surveillance, UK

Main Category: Pregnancy / Obstetrics
Also Included In: Women's Health / Gynecology
Article Date: 28 Oct 2007 - 16:00 PDT

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In the latest BJOG podcast, leading obstetricians from St George's University Hospital in London discuss the use of CTG-ST waveform analysis to monitor fetal heart rate performance during labour. The podcast accompanies the publication of two articles and a commentary in October's BJOG: An International Journal of Obstetrics and Gynaecology.

STAN is a new method of checking the progress made by a baby during labour. It uses cardiotography (CTG) to count the number of heart beats and combines that with monitoring the signals that generate the heart beat (ST analysis) to ensure that the baby is getting enough oxygen to the brain. It is believed that this method helps doctors to identify fetal stress and prevent hypoxia or acidosis.

In severe cases, babies suffering from a lack of oxygen have brain and tissue damage, difficulties with feeding and problems with their kidney or liver functions. Doctors believed that using STAN can help detect fetal stress at an early stage so that action is taken immediately. Previous randomised controlled trials have also shown that using STAN has led to a fall in caesarean sections.

In the podcast, Austin Ugwumadu describes the study that was done specifically on the 1,502 women who had high-risk pregnancies at St George's from 2002 - 05. These were women who had complications such as pre-eclampsia, babies who were not growing well in the womb, or risk factors such as a previous caesarean section. They were monitored using STAN. He explains how readings are taken and the indications for when action is needed.

Dr Aris Papageorghiou recommends that it is a requirement for staff to receive appropriate training in the use of STAN technology. A gradual introduction of these clinical skills into obstetric practice, including the assessment and certification of CTG and ST analysis will help improve the incidence of emergency operative deliveries and neonatal encephalopathy. Their research demonstrated that the accurate interpretations of the CTG are key to identifying problems.

According to Professor Sabaratnam Arulkumaran, in order for the benefits of STAN to be harnessed, it is also important for doctors to follow the current guidelines on the use of STAN. This helps prevent delay in taking immediate action after an abnormal STAN reading. He recommends that a dedicated member of staff, preferably a senior specialist midwife, during each shift, is tasked with monitoring STAN, every hour on the dot to ensure that accurate readings are taken regularly.

Dr Steve Walkinshaw, BJOG deputy editor-in-chief, said "The introduction of any new technology that might both result in more timely birth of the baby and reduce the caesarean section rate would be welcomed, but the research published this month shows that proper and continuous training is needed to maximise any advantage. It also emphasises that expertise in the interpretation of the CTG has to be practised alongside the new technology."

Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Blackwell Publishing. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote 'BJOG' or 'BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal.

The podcast refers to these three articles published in October's BJOG:

- 'Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance'
- 'Limitations of ST-analysis in clinical practice: three cases of intrapartum metabolic acidosis.'
- 'Review of the first 1502 cases of ECG-ST waveform analysis during labour in a teaching hospital'

All three articles can be accessed from the BJOG podcast page:
http://www.blackwellpublishing.com/podcast/bjog.asp

References

- I Amer-Wahlin, S Arulkumaran, H Hagberg, K Maršál, GHA Visser 2007 Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance. BJOG: An International Journal of Obstetrics and Gynaecology 114 :1191-1193. doi:10.1111/j.1471-0528.2007.01479.x

- MEMH Westerhuis, A Kwee, AA van Ginkel, AP Drogtrop, WJA Gyselaers, GHA Visser 2007 Limitations of ST analysis in clinical practice: three cases of intrapartum metabolic acidosis. BJOG: An International Journal of Obstetrics and Gynaecology 114:1194-1201. doi:10.1111/j.1471-0528.2007.01236.x

- V Doria, AT Papageorghiou, A Gustafsson, A Ugwumadu, K Farrer, S Arulkumaran 2007 Review of the first 1502 cases of ECG-ST waveform analysis during labour in a teaching hospital. BJOG: An International Journal of Obstetrics and Gynaecology 114:1202-1207. doi:10.1111/j.1471-0528.2007.01480.x

Royal College of Obstetricians and Gynaecologists

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