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Cochrane Database of Systematic Reviews

Fetal electrocardiogram (ECG) for fetal monitoring during labour

Information

DOI:
https://doi.org/10.1002/14651858.CD000116.pub5Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 21 December 2015see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Pregnancy and Childbirth Group

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • James P Neilson

    Correspondence to: Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK

    [email protected]

Contributions of authors

JP Neilson has prepared and maintained the review.

Sources of support

Internal sources

  • The University of Liverpool, UK.

External sources

  • No sources of support supplied

Declarations of interest

None known.

Acknowledgements

Thanks for additional unpublished data from Dr Jenny Westgate (Westgate 1993), Dr Christophe Vayssiere (Vayssiere 2007), and Prof Karel Marsal (Amer‐Wahlin 2001).

Thanks also to Becky Davie and Sally Reynolds, student medical statisticians, who helped with the 'Risk of bias' assessments of included studies (and to Leanne Jones for her oversight).

This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to Cochrane Pregnancy and Childbirth. The views and opinions expressed therein are those of the author and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2015 Dec 21

Fetal electrocardiogram (ECG) for fetal monitoring during labour

Review

James P Neilson

https://doi.org/10.1002/14651858.CD000116.pub5

2013 May 31

Fetal electrocardiogram (ECG) for fetal monitoring during labour

Review

James P Neilson

https://doi.org/10.1002/14651858.CD000116.pub4

2012 Apr 18

Fetal electrocardiogram (ECG) for fetal monitoring during labour

Review

James P Neilson

https://doi.org/10.1002/14651858.CD000116.pub3

2006 Jul 19

Fetal electrocardiogram (ECG) for fetal monitoring during labour

Review

James P Neilson

https://doi.org/10.1002/14651858.CD000116.pub2

2003 Apr 22

Fetal electrocardiogram (ECG) for fetal monitoring during labour

Review

James P Neilson

https://doi.org/10.1002/14651858.CD000116

Differences between protocol and review

Methods updated. A 'Summary of findings' table has been added.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 1

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 1 Caesarean section.
Figures and Tables -
Analysis 1.1

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 1 Caesarean section.

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 2 Cord pH < 7.05 + base deficit > 12 mmol/L.
Figures and Tables -
Analysis 1.2

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 2 Cord pH < 7.05 + base deficit > 12 mmol/L.

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 3 Neonatal encephalopathy.
Figures and Tables -
Analysis 1.3

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 3 Neonatal encephalopathy.

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 4 Fetal blood sampling.
Figures and Tables -
Analysis 1.4

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 4 Fetal blood sampling.

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 5 Operative vaginal delivery.
Figures and Tables -
Analysis 1.5

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 5 Operative vaginal delivery.

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 6 Apgar score < 7 at 5 minutes.
Figures and Tables -
Analysis 1.6

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 6 Apgar score < 7 at 5 minutes.

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 7 Neonatal intubation.
Figures and Tables -
Analysis 1.7

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 7 Neonatal intubation.

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 8 Admission neonatal special care unit.
Figures and Tables -
Analysis 1.8

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 8 Admission neonatal special care unit.

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 9 Perinatal death.
Figures and Tables -
Analysis 1.9

Comparison 1 Fetal ECG plus CTG versus CTG alone, Outcome 9 Perinatal death.

Summary of findings for the main comparison. Fetal electrocardiogram (ECG) (ST analysis) plus cardiotocography (CTG) versus CTG alone for fetal monitoring during labour

Fetal ECG (ST analysis) plus CTG versus CTG alone for fetal monitoring during labour

Patient or population: Pregnant women (and their fetuses) in labour, with a perceived need for continuous electronic fetal heart rate monitoring
Settings: Sweden, USA, Finland, France, The Netherlands, UK.
Intervention: Fetal ECG (ST analysis) plus CTG
Comparison: CTG alone

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with CTG alone

Risk with Fetal ECG plus CTG

Caesarean section ‐ ST analysis

Study population

RR 1.02
(0.96 to 1.08)

26,446
(6 RCTs)

⊕⊕⊕⊕
high

135 per 1000

137 per 1000
(129 to 145)

Moderate

119 per 1000

121 per 1000
(114 to 128)

Cord pH less than 7.05 and base deficit greater than 12 mmol/L ‐ ST analysis

Study population

RR 0.72
(0.43 to 1.20)

25,682
(6 RCTs)

⊕⊕⊕⊝
moderate1

9 per 1000

7 per 1000
(4 to 11)

Moderate

11 per 1000

8 per 1000
(5 to 13)

Neonatal encephalopathy ‐ ST analysis

Study population

RR 0.61
(0.30 to 1.22)

26,410
(6 RCTs)

⊕⊕⊕⊕
high

2 per 1000

1 per 1000
(0 to 2)

Moderate

2 per 1000

1 per 1000
(1 to 2)

Fetal blood sampling ‐ ST analysis

Study population

RR 0.61
(0.41 to 0.91)

9671
(4 RCTs)

⊕⊕⊕⊕
high

154 per 1000

94 per 1000
(63 to 140)

Moderate

131 per 1000

80 per 1000
(54 to 119)

Operative vaginal delivery ‐ ST analysis

Study population

RR 0.92
(0.86 to 0.99)

26,446
(6 RCTs)

⊕⊕⊕⊕
high

113 per 1000

104 per 1000
(97 to 112)

Moderate

133 per 1000

122 per 1000
(114 to 131)

Admission to neonatal special care unit ‐ ST analysis

Study population

RR 0.96
(0.89 to 1.04)

26410
(6 RCTs)

⊕⊕⊕⊕
high

88 per 1000

84 per 1000
(78 to 91)

Moderate

55 per 1000

53 per 1000
(49 to 57)

Perinatal death ‐ ST analysis

Study population

RR 1.71
(0.67 to 4.33)

26,446
(6 RCTs)

⊕⊕⊕⊕
high

0 per 1000

1 per 1000
(0 to 2)

Moderate

0 per 1000

1 per 1000
(0 to 2)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Some heterogeneity in findings (I2 55%)

Figures and Tables -
Summary of findings for the main comparison. Fetal electrocardiogram (ECG) (ST analysis) plus cardiotocography (CTG) versus CTG alone for fetal monitoring during labour
Comparison 1. Fetal ECG plus CTG versus CTG alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Caesarean section Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 ST analysis

6

26446

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.96, 1.08]

1.2 PR analysis

1

957

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.61, 1.04]

2 Cord pH < 7.05 + base deficit > 12 mmol/L Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 ST analysis

6

25682

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.43, 1.20]

2.2 PR analysis

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Neonatal encephalopathy Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 ST analysis

6

26410

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.30, 1.22]

3.2 PR analysis

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Fetal blood sampling Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 ST analysis

4

9671

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.41, 0.91]

4.2 PR analysis

1

957

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.69, 1.19]

5 Operative vaginal delivery Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 ST analysis

6

26446

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.86, 0.99]

5.2 PR analysis

1

957

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.75, 1.17]

6 Apgar score < 7 at 5 minutes Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 ST analysis

5

15302

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.73, 1.24]

6.2 PR analysis

1

957

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.11, 1.62]

7 Neonatal intubation Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 ST analysis

2

12544

Risk Ratio (M‐H, Fixed, 95% CI)

1.37 [0.89, 2.11]

7.2 PR analysis

1

957

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.26, 2.11]

8 Admission neonatal special care unit Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 ST analysis

6

26410

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.89, 1.04]

8.2 PR analysis

1

957

Risk Ratio (M‐H, Fixed, 95% CI)

0.77 [0.45, 1.33]

9 Perinatal death Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 ST analysis

6

26446

Risk Ratio (M‐H, Fixed, 95% CI)

1.71 [0.67, 4.33]

9.2 PR analysis

1

957

Risk Ratio (M‐H, Fixed, 95% CI)

2.96 [0.12, 72.39]

Figures and Tables -
Comparison 1. Fetal ECG plus CTG versus CTG alone