A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part I: The randomized controlled trials

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

Research output: Contribution to journalReview article

16 Citations (Scopus)

Abstract

We reappraised the five randomized controlled trials that compared cardiotocography plus ECG ST interval analysis (CTG+ST) vs. cardiotocography. The numbers enrolled ranged from 5681 (Dutch randomized controlled trial) to 799 (French randomized controlled trial). The Swedish randomized controlled trial (n = 5049) was the only trial adequately powered to show a difference in metabolic acidosis, and the Plymouth randomized controlled trial (n = 2434) was only powered to show a difference in operative delivery for fetal distress. There were considerable differences in study design: the French randomized controlled trial used different inclusion criteria, and the Finnish randomized controlled trial (n = 1483) used a different metabolic acidosis definition. In the CTG+ST study arms, the larger Plymouth, Swedish and Dutch trials showed lower operative delivery and metabolic acidosis rates, whereas the smaller Finnish and French trials showed minor differences in operative delivery and higher metabolic acidosis rates. We conclude that the differences in outcomes are likely due to the considerable differences in study design and size. This will enhance heterogeneity effects in any subsequent meta-analysis.

Original languageEnglish (US)
Pages (from-to)556-568
Number of pages13
JournalActa Obstetricia et Gynecologica Scandinavica
Volume93
Issue number6
DOIs
StatePublished - Jan 1 2014

Fingerprint

Cardiotocography
Electrocardiography
Randomized Controlled Trials
Acidosis
Fetal Distress
Meta-Analysis

Keywords

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

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part I : The randomized controlled trials. / Olofsson, Per; Ayres-De-Campos, Diogo; Kessler, Jörg; Tendal, Britta; Yli, Branka M.; Devoe, Lawrence D.

In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 93, No. 6, 01.01.2014, p. 556-568.

Research output: Contribution to journalReview article

@article{b5752cdcdaef42c8a03cce4c98b2acbd,
title = "A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part I: The randomized controlled trials",
abstract = "We reappraised the five randomized controlled trials that compared cardiotocography plus ECG ST interval analysis (CTG+ST) vs. cardiotocography. The numbers enrolled ranged from 5681 (Dutch randomized controlled trial) to 799 (French randomized controlled trial). The Swedish randomized controlled trial (n = 5049) was the only trial adequately powered to show a difference in metabolic acidosis, and the Plymouth randomized controlled trial (n = 2434) was only powered to show a difference in operative delivery for fetal distress. There were considerable differences in study design: the French randomized controlled trial used different inclusion criteria, and the Finnish randomized controlled trial (n = 1483) used a different metabolic acidosis definition. In the CTG+ST study arms, the larger Plymouth, Swedish and Dutch trials showed lower operative delivery and metabolic acidosis rates, whereas the smaller Finnish and French trials showed minor differences in operative delivery and higher metabolic acidosis rates. We conclude that the differences in outcomes are likely due to the considerable differences in study design and size. This will enhance heterogeneity effects in any subsequent meta-analysis.",
keywords = "Cardiotocography, ST analysis, fetal surveillance, meta-analysis, metabolic acidosis, randomized controlled trial",
author = "Per Olofsson and Diogo Ayres-De-Campos and J{\"o}rg Kessler and Britta Tendal and Yli, {Branka M.} and Devoe, {Lawrence D}",
year = "2014",
month = "1",
day = "1",
doi = "10.1111/aogs.12413",
language = "English (US)",
volume = "93",
pages = "556--568",
journal = "Acta Obstetricia et Gynecologica Scandinavica",
issn = "0001-6349",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part I

T2 - The randomized controlled trials

AU - Olofsson, Per

AU - Ayres-De-Campos, Diogo

AU - Kessler, Jörg

AU - Tendal, Britta

AU - Yli, Branka M.

AU - Devoe, Lawrence D

PY - 2014/1/1

Y1 - 2014/1/1

N2 - We reappraised the five randomized controlled trials that compared cardiotocography plus ECG ST interval analysis (CTG+ST) vs. cardiotocography. The numbers enrolled ranged from 5681 (Dutch randomized controlled trial) to 799 (French randomized controlled trial). The Swedish randomized controlled trial (n = 5049) was the only trial adequately powered to show a difference in metabolic acidosis, and the Plymouth randomized controlled trial (n = 2434) was only powered to show a difference in operative delivery for fetal distress. There were considerable differences in study design: the French randomized controlled trial used different inclusion criteria, and the Finnish randomized controlled trial (n = 1483) used a different metabolic acidosis definition. In the CTG+ST study arms, the larger Plymouth, Swedish and Dutch trials showed lower operative delivery and metabolic acidosis rates, whereas the smaller Finnish and French trials showed minor differences in operative delivery and higher metabolic acidosis rates. We conclude that the differences in outcomes are likely due to the considerable differences in study design and size. This will enhance heterogeneity effects in any subsequent meta-analysis.

AB - We reappraised the five randomized controlled trials that compared cardiotocography plus ECG ST interval analysis (CTG+ST) vs. cardiotocography. The numbers enrolled ranged from 5681 (Dutch randomized controlled trial) to 799 (French randomized controlled trial). The Swedish randomized controlled trial (n = 5049) was the only trial adequately powered to show a difference in metabolic acidosis, and the Plymouth randomized controlled trial (n = 2434) was only powered to show a difference in operative delivery for fetal distress. There were considerable differences in study design: the French randomized controlled trial used different inclusion criteria, and the Finnish randomized controlled trial (n = 1483) used a different metabolic acidosis definition. In the CTG+ST study arms, the larger Plymouth, Swedish and Dutch trials showed lower operative delivery and metabolic acidosis rates, whereas the smaller Finnish and French trials showed minor differences in operative delivery and higher metabolic acidosis rates. We conclude that the differences in outcomes are likely due to the considerable differences in study design and size. This will enhance heterogeneity effects in any subsequent meta-analysis.

KW - Cardiotocography

KW - ST analysis

KW - fetal surveillance

KW - meta-analysis

KW - metabolic acidosis

KW - randomized controlled trial

UR - http://www.scopus.com/inward/record.url?scp=84901622074&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901622074&partnerID=8YFLogxK

U2 - 10.1111/aogs.12413

DO - 10.1111/aogs.12413

M3 - Review article

C2 - 24797452

AN - SCOPUS:84901622074

VL - 93

SP - 556

EP - 568

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

IS - 6

ER -