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Our objective was to quantify the efficacy of <jats:styled-content style=\"fixed-case\">ST<\/jats:styled-content> waveform analysis vs. cardiotocography and assess the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation tool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We identified randomized controlled trials through systematic literature searches and assessed included studies for risk of bias. Meta\u2010analyses were performed, calculating pooled risk ratio or peto odds ratio. We performed post hoc trial sequential analyses for selected outcomes to assess the risk of false\u2010positive results and the need for additional studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six randomized controlled trials were included in the meta\u2010analysis. <jats:styled-content style=\"fixed-case\">ST<\/jats:styled-content> waveform analysis was not associated with a reduction in operative deliveries due to fetal distress, but we observed a significantly lower rate of metabolic acidosis (peto odds ratio 0.64; 95% confidence interval 0.46\u20130.88). Accordingly, 401 women need to be monitored with <jats:styled-content style=\"fixed-case\">ST<\/jats:styled-content> waveform analysis to prevent one case of metabolic acidosis. No statistically significant effects were observed in other fetal or neonatal outcomes, except from fetal blood sampling (risk ratio 0.59; 95% confidence interval 0.45\u20130.79) and a minor reduction in the number of operative vaginal deliveries for all indications (risk ratio 0.92; 95% confidence interval 0.86\u20130.99). The quality of the evidence was high to moderate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Absolute effects of <jats:styled-content style=\"fixed-case\">ST<\/jats:styled-content> waveform analysis were minor, and the clinical significance of the observed reduction in metabolic acidosis is questioned. There is not enough evidence to justify the use of <jats:styled-content style=\"fixed-case\">ST<\/jats:styled-content> waveform analysis in contemporary obstetrics.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.12828","type":"journal-article","created":{"date-parts":[[2015,11,26]],"date-time":"2015-11-26T13:41:36Z","timestamp":1448545296000},"page":"16-27","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta\u2010analysis of randomized trials"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7971-4580","authenticated-orcid":false,"given":"Ellen","family":"Blix","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences Oslo and Akershus University College of Applied Sciences Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5920-4652","authenticated-orcid":false,"given":"Kjetil G.","family":"Brurberg","sequence":"additional","affiliation":[{"name":"The Norwegian Knowledge Center for the Health Services Oslo Norway"},{"name":"Center for Evidence Based Practice Bergen University College Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8877-2192","authenticated-orcid":false,"given":"Eirik","family":"Reierth","sequence":"additional","affiliation":[{"name":"Science and Health Library University Library UiT The Arctic University of Norway Troms\u00f8 Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8135-848X","authenticated-orcid":false,"given":"Liv M.","family":"Reinar","sequence":"additional","affiliation":[{"name":"The Norwegian Knowledge Center for the Health Services Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e5l","family":"\u00d8ian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospital of North Norway Troms\u00f8 Norway"},{"name":"Department of Clinical Medicine UiT The Arctic University of Norway Troms\u00f8 Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,12,19]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"CD006066","article-title":"Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour","volume":"5","author":"Alfirevic Z","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.gco.0000162183.68725.83"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(92)90465-F"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)05703-8"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.00886.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.07.007"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181dfffd6"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1314886"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31823d8230"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12009"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.01.028"},{"key":"e_1_2_8_13_1","first-page":"CD000116","article-title":"Fetal electrocardiogram (ECG) for fetal monitoring during labour","volume":"5","author":"Neilson JP","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12412"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1500600"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12782"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.03.013"},{"key":"e_1_2_8_19_1","volume-title":"Cochrane handbook for systematic review of interventions","author":"Higgins JPT","year":"2011"},{"key":"e_1_2_8_20_1","volume-title":"Cochrane handbook for systematic review of interventions","author":"Higgins JPT","year":"2011"},{"key":"e_1_2_8_21_1","volume-title":"Team R: a language and environment for statistical computing","author":"Team RC","year":"2014"},{"key":"e_1_2_8_22_1","unstructured":"GordonM LumleyT.Forest plot: advanced forest plot using \u201cgrid\u201d graphics. 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