{"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":1784829585402,"version":"3.55.0"},"reference-count":46,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T00:00:00Z","timestamp":1702425600000},"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":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We performed systematic literature searches to identify randomized controlled trials and assessed included studies for risk of bias. We performed meta\u2010analyses, 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\u2010positive results and the need for additional studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nine randomized controlled trials including 28\u2009729 women were included in the meta\u2010analysis. 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\u20131.11). STAN was associated with a significantly lower rate of metabolic acidosis (0.45% vs 0.68%; Peto OR 0.66; 95% CI 0.48\u20130.90). 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\u20130.80). 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 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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14752","type":"journal-article","created":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T10:29:30Z","timestamp":1702549770000},"page":"437-448","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["<scp>ST<\/scp> waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta\u2010analysis of randomized trials"],"prefix":"10.1111","volume":"103","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 Metropolitan University  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kjetil Gundro","family":"Brurberg","sequence":"additional","affiliation":[{"name":"The Norwegian Institute of Public Health  Oslo Norway"},{"name":"Center for Evidence Based Practice Western Norway University of Applied Sciences  Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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"}]},{"given":"Liv Merete","family":"Reinar","sequence":"additional","affiliation":[{"name":"The Norwegian Institute of Public Health  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"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12,13]]},"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":"2017","author":"Alfirevic Z","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.gco.0000162183.68725.83"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12828"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001198"},{"key":"e_1_2_10_6_1","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_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)05703-8"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1500600"},{"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":"10.1016\/0140-6736(92)90465-F"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01203.x"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182083dcd"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.202538"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.03.013"},{"key":"e_1_2_10_18_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions version 6.4","author":"Higgins JPT","year":"2023"},{"key":"e_1_2_10_19_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions version 6.3","author":"Deeks JJ","year":"2022"},{"key":"e_1_2_10_20_1","volume-title":"Team R: a Language and Environment for Statistical Computing","author":"Team RC","year":"2014"},{"key":"e_1_2_10_21_1","unstructured":"GordonM LumleyT.Forestplot: Advanced Forest Plot Using \"grid\" Graphics. 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