{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:59:45Z","timestamp":1784829585657,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T00:00:00Z","timestamp":1647216000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>ST segment analysis (STAN) of the fetal electrocardiogram was introduced as an adjunct to cardiotocography for intrapartum fetal monitoring 30\u00a0years ago. We examined the impact of the introduction of STAN on changes in the occurrence of fetal and neonatal deaths, Apgar scores of &lt;7 at 5\u00a0min, intrapartum cesarean sections, and instrumental vaginal deliveries while controlling for time\u2010 and hospital\u2010specific trends and maternal risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>Data were retrieved from the Medical Birth Registry of Norway from 1985 to 2014. Individual data were linked to the Education Registry and the Central Person Registry. The study sample included 1\u00a0132\u2009022 singleton births with a gestational age of 36\u00a0weeks or beyond. Information about the year of STAN introduction was collected from every birth unit in Norway using a questionnaire. Our data structure consisted of a hospital\u2010year panel. We applied a linear probability model with hospital\u2010fixed effects and with adjustment for potentially confounding factors. The prevalence of the outcomes before and after the introduction of STAN were compared within each birth unit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 23 birth units, representing 76% of all births in Norway, had introduced the STAN technology. During the study period, stillbirths declined from 2.6 to 1.9 per 1000 births, neonatal deaths declined from 1.7 to 0.7 per 1000 live births, babies with Apgar score\u00a0&lt;7 at 5\u00a0min after birth increased from 7.4 to 9.5 per 1000 births, intrapartum cesarean sections increased from 6.4% to 9.5%, and instrumental vaginal deliveries increased from 7.8% to 10.9%. Our analyses found that the introduction of STAN was not associated with the decline in proportion of stillbirths (<jats:italic>p<\/jats:italic>\u00a0=0.76) and neonatal deaths (<jats:italic>p<\/jats:italic>\u00a0=0.76) or with the increase in intrapartum cesarean sections (<jats:italic>p<\/jats:italic>\u00a0=0.92) and instrumental vaginal deliveries (<jats:italic>p<\/jats:italic>\u00a0=0.78). However, it was associated with the increased occurrence of Apgar score &lt;7 at 5\u00a0min (<jats:italic>p<\/jats:italic>\u00a0=0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is no evidence that the introduction of STAN contributed to changes in the rates of stillbirths, neonatal deaths, intrapartum cesarean sections, or instrumental vaginal deliveries. There was an association between the introduction of STAN and a small increase in neonates with low Apgar scores.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14347","type":"journal-article","created":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T06:57:14Z","timestamp":1647327434000},"page":"809-818","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The impact of the introduction of intrapartum fetal <scp>ECG ST<\/scp> segment analysis. A population study"],"prefix":"10.1111","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7971-4580","authenticated-orcid":false,"given":"Ellen","family":"Blix","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences OsloMet \u2013 Oslo Metropolitan University  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2756-1583","authenticated-orcid":false,"given":"Anne","family":"Eskild","sequence":"additional","affiliation":[{"name":"Akershus University Hospital  L\u00f8renskog Norway"},{"name":"Institute of Clinical Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Skau","sequence":"additional","affiliation":[{"name":"Department of Community Dentistry University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jostein","family":"Grytten","sequence":"additional","affiliation":[{"name":"Department of Community Dentistry University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,14]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"CD006066","article-title":"Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour","volume":"2","author":"Alfirevic Z","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(85)90619-2"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(89)91848-5"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12721"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.gco.0000162183.68725.83"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(92)90465-F"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)05703-8"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.00886.x"},{"issue":"299","key":"e_1_2_10_10_1","first-page":"e1","article-title":"A French randomized controlled trial of ST\u2010segment analysis in a population with abnormal cardiotocograms during labor","volume":"197","author":"Vayssiere C","year":"2007","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181dfffd6"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1500600"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2019.01.023"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12828"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001198"},{"issue":"12","key":"e_1_2_10_16_1","first-page":"CD000116","article-title":"Fetal electrocardiogram (ECG) for fetal monitoring during labour","volume":"2015","author":"Neilson JP","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14160"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14158"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.04.003"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.03.017"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.02.049"},{"key":"e_1_2_10_22_1","unstructured":"Barrab\u00e9sN \u00d8stliGK.Norwegian standard classification of education 2016. 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