IMPROVED INTRAPARTUM SURVEILLANCE WITH PR INTERVAL-ANALYSIS OF THE FETAL ELECTROCARDIOGRAM - A RANDOMIZED TRIAL SHOWING A REDUCTION IN FETAL BLOOD-SAMPLING

OBJECTIVE: Our goal was to test the hypothesis that the addition of fe tal electrocardiogram time-interval analysis to conventional electroni c fetal monitoring would significantly reduce the number of cases requ iring fetal scalp blood sampling without an increase in adverse outcom e. STUDY DESIGN: A randomized prospective trial was performed in 214 w omen with high-risk labor. RESULTS: There was a significant reduction in the number of cases that had fetal blood sampling performed in the fetal electrocardiogram plus electronic fetal monitoring group (risk r atio for electronic fetal monitoring alone 3.53; p < 0.01, 95% confide nce interval 1.39 to 8.95). The fetal blood samplings performed in the electronic fetal monitoring alone group were less likely to be abnorm al (pH <7.25, base excess < -8.0) than those performed in the fetal el ectrocardiogram plus electronic fetal monitoring group (risk ratio for electronic fetal monitoring alone 0.62, p = 0.05, 95% confidence inte rval 0.35 to 1.10). There was a trend of more infants with an arterial umbilical pH < 7.15 and a base excess less than -8.0 mmol/L at birth being unsuspected and more instrumental deliveries for presumed fetal distress being performed in the electronic fetal monitoring alone than in the fetal electrocardiogram plus electronic fetal monitoring group . CONCLUSION: The addition of fetal electrocardiogram analysis to conv entional electronic fetal monitoring during labor can reduce significa ntly the number of parturients undergoing fetal scalp blood sampling a nd can simultaneously increase its efficiency without an increase in a dverse outcome.