Abstract
ST waveform analysis of fetal electrocardiogram (ECG) for intrapartum surveillance (STAN) is a newly introduced method for fetal surveillance. The purpose of this commentary is to assist in the proper use of fetal ECG in combination with cardiotocography (CTG) during labour. Guidelines and recommendations concerning CTG and ST waveform interpretation and classification are stated that were agreed on by the European experts on ST waveform analysis for intrapartum surveillance during a meeting in Utretcht, the Netherlands in January 2007.
Highlights
Please cite this paper as: Amer-Wahlin I, Arulkumaran S, Hagberg H, Marsal K, Visser G
The technique was developed in Sweden and has widespread use in Scandinavia with the help of ‘expert’ centres, which help in education and training
Before starting STAN d .36 1 0 gestational weeks d Ruptured membranes d No contraindication for scalp electrode d First stage, no active or involuntary pushing at onset After start-up d Normal ECG waveform with sufficient signal quality d Event log message baseline determined d Check for reactivity and nondeteriorating fetal state at the onset of a STAN recording, classify fetal heart rate (FHR)!
Summary
A checklist was suggested to be used at the start of recording (Table 1). STAN calculates the initial reference baseline T/QRS using the first 20 T/QRS data recorded and resets the baseline if it becomes lower or after 3 hours of recording. A ST rise is detected when a sequence of T/QRS data are recorded, which significantly exceeds this T/QRS baseline, and an ST event is flagged by the computer. Before starting STAN d .36 1 0 gestational weeks d Ruptured membranes d No contraindication for scalp electrode d First stage, no active or involuntary pushing at onset After start-up d Normal ECG waveform with sufficient signal quality d Event log message baseline determined d Check for reactivity and nondeteriorating fetal state at the onset of a STAN recording, classify FHR!. Absence of ST events in a situation with nonreassuring FHR trace from the start could be related to previous compromise in a fetus that is unable to respond with ECG changes. If additional assessment of the fetal condition in such a case is not possible, the need for intervention should be based on FHR, clinical situation and fetal blood sampling (FBS) but not on STAN information
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