Key result
Relative ST-event rises on fetal ECG detect metabolic acidosis with ~90% sensitivity.
Why the study?
The diagnostic value of ST analysis of the fetal ECG during labor is uncertain due to false alarms caused by physiological variation of the fetal electrical heart axis.
Does adjusting the definition of ST events to a relative rise improve the detection of fetal metabolic acidosis in term singleton fetuses during labor?
Observational (n=1,328)
Does adjusting the definition of ST events to a relative rise improve the detection of fetal metabolic acidosis in term singleton fetuses during labor?
Effect estimate: Sensitivity 90%, Specificity 80%
Adjusting the definition of ST events to a relative rise of 85% from baseline provides high sensitivity and specificity for detecting fetal metabolic acidosis, potentially improving fECG diagnostic accuracy.
Relative ST thresholds may aid intrapartum acidosis detection; hypothesis-generating and requires prospective validation before practice change.
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.
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Hulsenboom et al. (2022) conducted an observational in Fetal metabolic acidosis (n=1,328). Relative ST events in fECG was evaluated on Cut-off value for relative ST events to detect fetal metabolic acidosis (Sensitivity 90%, Specificity 80%). Relative ST events in fetal ECG, using an optimal cut-off of an 85% increment from baseline, detected fetal metabolic acidosis with 90% sensitivity and 80% specificity.
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