![]() ![]() ![]() In comparison to continuous electronic fetal heart rate monitoring alone, the use of adjunctive ST waveform analysis made no obvious difference to primary outcomes: births by caesarean section (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.96 to 1.08 six trials, 26,446 women high quality evidence) the number of babies with severe metabolic acidosis at birth (cord arterial pH less than 7.05 and base deficit greater than 12 mmol/L) (average RR 0.72, 95% CI 0.43 to 1.20 six trials, 25,682 babies moderate quality evidence) or babies with neonatal encephalopathy (RR 0.61, 95% CI 0.30 to 1.22 six trials, 26,410 babies high quality evidence). The trials were generally at low risk of bias for most domains and the quality of evidence for ST waveform analysis trials was graded moderate to high. Seven trials (27,403 women) were included: six trials of ST waveform analysis (26,446 women) and one trial of PR interval analysis (957 women). The evidence was found to be of high quality. There was no difference in the number of caesarean deliveries and little to suggest that babies were in better condition at birth. This review of seven randomised controlled trials, including a total of 27,403 women, found that monitoring the baby using ECG plus CTG resulted in fewer blood samples needing to be taken from the baby's scalp, and less surgical assistance with the birth, than with CTG alone. This involves an electrode being passed through the woman's cervix and attached to the baby's head. An ECG measures the heart's electrical activity and the pattern of the heart beats. CTG measures the baby's heart rate together with the mother's uterine contractions. Electronic heart monitoring may be suggested if the doctors think the baby is not getting enough oxygen during labour. Usually the baby has sufficient reserve to withstand this effect but some may become distressed. The umbilical cord may also be compressed during labour, especially if the membranes are ruptured. Strong uterine contractions during labour reduce the flow of maternal blood to the placenta. Monitoring the baby's heart using electrocardiography (ECG) plus cardiotocography (CTG) during labour provides some modest help for mothers and babies when continuous monitoring is needed. ![]()
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