New possibilities for ST analysis - A post-hoc analysis on the Dutch STAN RCT

A D J Hulsenboom; M B Van der Hout-van der Jagt; E S A van den Akker; P C A M Bakker; E van Beek; A P Drogtrop; A Kwee; M E M H Westerhuis; R J P Rijnders; N W E Schuitemaker; C Willekes; R Vullings; S G Oei; J O E H van Laar

doi:10.1016/j.earlhumdev.2021.105537

New possibilities for ST analysis - A post-hoc analysis on the Dutch STAN RCT

Early Hum Dev. 2022 Mar:166:105537. doi: 10.1016/j.earlhumdev.2021.105537. Epub 2022 Jan 13.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands. Electronic address: adj.hulsenboom@gmail.com.
² Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Faculty of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Faculty of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands.
³ Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, the Netherlands.
⁴ Department of Obstetrics and Gynecology, Amsterdam University Medical Center, location VUmc, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
⁵ Department of Obstetrics and Gynecology, St. Antonius Hospital, P.O. Box 2500, 3430 EM Nieuwegein, the Netherlands.
⁶ Department of Obstetrics and Gynecology, Elisabeth Tweesteden Hospital, P.O. Box 90151, LC 5000 Tilburg, the Netherlands.
⁷ Department of Obstetrics and Gynecology, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, the Netherlands.
⁸ Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, ZA 5602 Eindhoven, the Netherlands.
⁹ Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME Hertogenbosch, the Netherlands.
¹⁰ Department of Obstetrics and Gynecology, Diakonessenhuis, P.O. Box 80250, 3508 TG Utrecht, the Netherlands.
¹¹ Department of Obstetrics and Gynecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
¹² Faculty of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands.
¹³ Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Faculty of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands.
¹⁴ Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands.

PMID: 35091162
DOI: 10.1016/j.earlhumdev.2021.105537

Abstract

Background: The diagnostic value of ST analysis of the fetal electrocardiogram (fECG) during labor is uncertain. False alarms (ST events) may be explained by physiological variation of the fetal electrical heart axis. Adjusted ST events, based on a relative rather than an absolute rise from baseline, correct for this variation and may improve the diagnostic accuracy of ST analysis.

Aims: Determine the optimal cut-off for relative ST events in fECG to detect fetal metabolic acidosis.

Study design: Post-hoc analysis on fECG tracings from the Dutch STAN trial (STAN+CTG branch).

Subjects: 1328 term singleton fetuses with scalp ECG tracing during labor, including 10 cases of metabolic acidosis.

Outcome measures: Cut-off value for relative ST events at the point closest to (0,1) in the receiver operating characteristic (ROC) curve with corresponding sensitivity and specificity.

Results: Relative baseline ST events had an optimal cut-off at an increment of 85% from baseline. Relative ST events had a sensitivity of 90% and specificity of 80%.

Conclusions: Adjusting the current definition of ST events may improve ST analysis, making it independent of CTG interpretation.

Keywords: Fetal electrocardiography; Fetal monitoring; Metabolic acidosis; ST event; T/QRS.

Publication types

Randomized Controlled Trial

MeSH terms

Acidosis* / diagnosis
Cardiotocography
Electrocardiography
Female
Fetal Heart
Fetal Monitoring
Heart Rate, Fetal
Humans
Labor, Obstetric*
Pregnancy