Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.
Akershus University Hospital, Lørenskog, Norway.
Acta Obstet Gynecol Scand. 2022 Jul;101(7):809-818. doi: 10.1111/aogs.14347. Epub 2022 Mar 14.
ST segment analysis (STAN) of the fetal electrocardiogram was introduced as an adjunct to cardiotocography for intrapartum fetal monitoring 30 years ago. We examined the impact of the introduction of STAN on changes in the occurrence of fetal and neonatal deaths, Apgar scores of <7 at 5 min, intrapartum cesarean sections, and instrumental vaginal deliveries while controlling for time- and hospital-specific trends and maternal risk factors.
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 1 132 022 singleton births with a gestational age of 36 weeks 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-year panel. We applied a linear probability model with hospital-fixed 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.
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 <7 at 5 min 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 (p =0.76) and neonatal deaths (p =0.76) or with the increase in intrapartum cesarean sections (p =0.92) and instrumental vaginal deliveries (p =0.78). However, it was associated with the increased occurrence of Apgar score <7 at 5 min (p =0.01).
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.
30 年前，胎儿心电图的 ST 段分析（STAN）被引入作为产时胎儿监测的胎心监护图的辅助手段。我们研究了 STAN 的引入对胎儿和新生儿死亡、5 分钟时 Apgar 评分<7、产时剖宫产和器械性阴道分娩发生率变化的影响，同时控制了时间和医院特定趋势以及产妇危险因素。
数据来自挪威医学出生登记处 1985 年至 2014 年的数据。个人数据与教育登记处和中央人员登记处相关联。研究样本包括 1132022 例胎龄为 36 周或以上的单胎分娩。从挪威的每个分娩单位收集有关 STAN 引入年份的信息，采用问卷形式。我们的数据结构由医院-年份面板组成。我们采用带有医院固定效应的线性概率模型，并对潜在混杂因素进行调整。在每个分娩单位内比较 STAN 引入前后结局的发生率。
共有 23 个分娩单位，代表挪威所有分娩的 76%，引入了 STAN 技术。在研究期间，死产率从每 1000 例活产 2.6 例降至 1.9 例，新生儿死亡率从每 1000 例活产 1.7 例降至 0.7 例，出生后 5 分钟 Apgar 评分<7 的婴儿比例从每 1000 例活产 7.4%升至 9.5%，产时剖宫产率从 6.4%升至 9.5%，器械性阴道分娩率从 7.8%升至 10.9%。我们的分析发现，STAN 的引入与死产率（p=0.76）和新生儿死亡率（p=0.76）的下降或产时剖宫产率（p=0.92）和器械性阴道分娩率（p=0.78）的增加无关。然而，它与出生后 5 分钟 Apgar 评分<7 的发生率增加有关（p=0.01）。
没有证据表明 STAN 的引入导致死产率、新生儿死亡率、产时剖宫产率或器械性阴道分娩率的变化。STAN 的引入与 Apgar 评分较低的新生儿比例略有增加有关。
