A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part II: The meta-analyses

Per Olofsson, Diogo Ayres-De-Campos, Jörg Kessler, Britta Tendal, Branka M. Yli, Lawrence Devoe

Research output: Contribution to journalReview article

27 Scopus citations


We appraised the methodology, execution and quality of the five published meta-analyses that are based on the five randomized controlled trials which compared cardiotocography (CTG)+ST analysis to cardiotocography. The meta-analyses contained errors, either created de novo in handling of original data or from a failure to recognize essential differences among the randomized controlled trials, particularly in their inclusion criteria and outcome parameters. No meta-analysis contained complete and relevant data from all five randomized controlled trials. We believe that one randomized controlled trial excluded in two of the meta-analyses should have been included, whereas one randomized controlled trial that was included in all meta-analyses, should have been excluded. After correction of the uncovered errors and exclusion of the randomized controlled trial that we deemed inappropriate, our new meta-analysis showed that CTG+ST monitoring significantly reduces the fetal scalp blood sampling usage (risk ratio 0.64; 95% confidence interval 0.47-0.88), total operative delivery rate (0.93; 0.88-0.99) and metabolic acidosis rate (0.61; 0.41-0.91).

Original languageEnglish (US)
Pages (from-to)571-586
Number of pages16
JournalActa Obstetricia et Gynecologica Scandinavica
Issue number6
StatePublished - Jun 2014



  • Cardiotocography
  • ST analysis
  • fetal surveillance
  • meta-analysis
  • metabolic acidosis
  • randomized controlled trial

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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