New possibilities for ST analysis – A post-hoc analysis on the Dutch STAN RCT. (March 2022)

• Record Type: Journal Article
• Authors: Hulsenboom, A.D.J.; Van der Hout-van der Jagt, M.B.; van den Akker, E.S.A.; Bakker, P.C.A.M.; van Beek, E.; Drogtrop, A.P.; Kwee, A.; Westerhuis, M.E.M.H.; Rijnders, R.J.P.; Schuitemaker, N.W.E.; Willekes, C.; Vullings, R.; Oei, S.G.; van Laar, J.O.E.H.
• Is Part Of: Early human development. Volume 166(2022)
• Publication Date: 2022-03
• Subjects: AUC area under curve -- BDecf base deficit in extracellular fluid -- CTG cardiotocography -- fECG fetal electrocardiography -- ROC receiver operating characteristic -- STAN ST analysis; Fetal electrocardiography -- Fetal monitoring -- ST event -- Metabolic acidosis -- T/QRS; Fetus -- Periodicals; Neonatology -- Periodicals; Prenatal influences -- Periodicals; 612.65
• DOI: 10.1016/j.earlhumdev.2021.105537
• Languages: English
• ISSNs: 0378-3782

Abstract

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. Highlights: Adjusting ST events may improve diagnostic accuracy for fetal metabolic acidosis during labor. Baseline ST events should be based on relative rises from baseline. ST events should be based on the total ECG registration (unrestricted memory).