Comparison of effect of CTG + STan with CTG alone on emergency Cesarean section rate: STan Australian Randomized controlled Trial (START)

Women's satisfaction with intrapartum fetal surveillance: A mixed-method study within the STan Australian randomised controlled trial (START)

BACKGROUND

Childbirth satisfaction can impact short and long-term health outcomes. In an Australian-first randomised controlled trial (RCT) (ACTRN1261800006268), two techniques for intrapartum fetal surveillance were compared; ST analysis (STan) as an adjunct to cardiotocography (CTG) compared to CTG alone. The aim was to determine if CTG+STan can reduce emergency caesarean section rates whilst maintaining or improving neonatal outcomes. This study compared women's experiences of and satisfaction with the two techniques of intrapartum fetal surveillance.

METHODS

N = 970 women were recruitment to the RCT between 2018 and 2021. We invited a consecutive sub-set of women (approximately the first half of the trial participants, n = 527) to complete a questionnaire at eight weeks postnatal. The analysis principle was intention to treat.

RESULTS

Of the n = 527 invited women, n = 207 completed the questionnaire (n = 113/265, CTG+STan; n = 94/265, CTG alone). Birth satisfaction was similar in both arms. Women in the CTG+STan arm reported higher satisfaction with staff competency in monitoring and more likely to disagree that they would prefer different monitoring methods in future labours. Qualitative findings highlighted, the main perceived difference between techniques was the use of the fetal scalp electrode (FSE), always used with CTG+STan and when clinically necessary utilised with CTG. Women viewed the FSE positively, as it allowed for greater mobility.

CONCLUSIONS

CTG+STan, provides comparable outcomes in terms of satisfaction with labour experience and monitoring. Findings should inform consumer-based information on electronic fetal surveillance, addressing common misconceptions among women and care providers about the potential use of a FSE.

TRIAL REGISTRATION

ANZCTR, ACTRN1261800006268. Registered on 19 January 2018.

Psychosocial outcomes from one cohort participating in the STan Australian Randomised controlled Trial (START)

BACKGROUND

In an Australian randomized controlled trial (RCT), two techniques for intrapartum fetal surveillance were compared: ST analysis (STan) as an adjunct to cardiotocography (CTG), compared with CTG alone. The aim was to determine whether CTG + STan could reduce emergency cesarean birth rates while maintaining or improving neonatal outcomes. Secondary aims were to compare clinical, economic, and psychosocial outcomes. The purpose of this paper was to present psychosocial outcomes from one cohort enrolled in the trial.

METHODS

The study was conducted at one tertiary referral hospital. Participants who had taken part in the trial from the outset were invited to complete a questionnaire between March 2018 and January 2020, approximately 8 weeks after giving birth. Outcomes included depression, psychological distress, health-related quality of life, and infant feeding practices. Analysis was by intention to treat.

RESULTS

N = 207/527 participants completed the questionnaire (n = 113, STan; n = 94, CTG alone). Overall, no statistically significant or clinically meaningful differences were found in the two groups for symptoms of depression, psychological distress, quality of life, or infant feeding. A statistically significant difference was observed for the subscale of pain-discomfort, where scores were higher on average in the CTG alone arm relative to that in the CTG + STan arm.

CONCLUSIONS

Although STan as an adjunct to CTG constitutes a different clinical technology from CTG alone, both monitoring types appeared to produce similar results in terms of postnatal psychosocial outcomes for women. Findings from this study provide service users and staff with a comprehensive assessment of STan that can be used to make evidence-informed decisions about monitoring options should STan become more widely available.

ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta-analysis of randomized trials

INTRODUCTION

ST waveform analysis (STAN) was introduced as an adjunct to cardiotocography (CTG) to improve neonatal and maternal outcomes. The aim of the present study was to quantify the efficacy of STAN vs CTG and assess the quality of the evidence using GRADE.

MATERIAL AND METHODS

We performed systematic literature searches to identify randomized controlled trials and assessed included studies for risk of bias. We performed meta-analyses, calculating pooled risk ratio (RR) or Peto odds ratio (OR). We also performed post hoc trial sequential analyses for selected outcomes to assess the risk of false-positive results and the need for additional studies.

RESULTS

Nine randomized controlled trials including 28 729 women were included in the meta-analysis. There were no differences between the groups in operative deliveries for fetal distress (10.9 vs 11.1%; RR 0.96; 95% confidence interval [CI] 0.82-1.11). STAN was associated with a significantly lower rate of metabolic acidosis (0.45% vs 0.68%; Peto OR 0.66; 95% CI 0.48-0.90). Accordingly, 441 women need to be monitored with STAN instead of CTG alone to prevent one case of metabolic acidosis. Women allocated to STAN had a reduced risk of fetal blood sampling compared with women allocated to conventional CTG monitoring (12.5% vs 19.6%; RR 0.62; 95% CI 0.49-0.80). The quality of the evidence was high to moderate.

CONCLUSIONS

Absolute effects of STAN were minor and the clinical significance of the observed reduction in metabolic acidosis is questioned. There is insufficient evidence to state that STAN as an adjunct to CTG leads to important clinical benefits compared with CTG alone.