The effect of maternal glucose administration on the specificity of the nonstress test. Non-stress antenatal cardiotocography--a prospective randomized clinical trial. A randomized controlled trial of non-stress antepartum cardiotocography. Cardiotocography plus ST analysis of fetal electrocardiogram compared with cardiotocography only for intrapartum monitoring: a randomized controlled trial. The value of antenatal cardiotocography in the management of high-risk pregnancy: a randomized controlled trial. Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial. A comparison of intrapartum automated fetal electrocardiography and conventional cardiotocography--a randomised controlled study. Using non-nutritive sucking and oral glucose solution with neonates to relieve pain: a randomised controlled trial. Admission cardiotocography: a randomised controlled trial.
To determine whether maternal glucose administration can decrease the incidence of false positive nonstress tests, 296 nonstress tests were performed on 235 high-risk obstetric patients in a prospective controlled study. Patients were alternately given a 50 gm oral glucose drink or an equal volume of water 30 minutes prior to the commencement of each test. Among "fed" patients (last meal within 2 hour of the nonstress test) whether receiving glucose or water, and "fasted" patients who received glucose, there was no significant difference in the percentage of reactive tests at either 20 minutes (65.2%) or 40 minutes (87.3%) of testing. However, patients fasting and receiving water had a significantly decreased percentage of reactive tests, both at 20 minutes (48.3%, P less than 0.01) and at 40 minutes (76.7%, P less than 0.05). Glucose administered to fasted patients resulted in an increase in the incidence of reactive tests, although this was not statistically significant. Glucose administration had no effect on the nonstress test results when administered to fed patients. A randomized controlled trial examined the effects of non-stress antepartum cardiotocography on obstetric management and assessed its usefulness as a diagnostic test of fetal compromise. Daily cardiotocograph recordings were made in 396 antenatal patients at increased risk of fetal compromise but were withheld from the clinicians responsible for care in half the cases. The frequency of intrapartum fetal distress and low Apgar score was similar in the two groups. The three normally-formed perinatal deaths all occurred in the revealed group but in only one case could earlier obstetric intervention have altered the outcome. Availability of non-stress cardiotocography was not associated with an increased rate of induction of labour or caesarean section. In a prospective randomized controlled study of non-stress antepartum cardiotocography (CTG), involving 569 tracings in 300 patients, "non-reactive' traces showed a significant association with still-births and neonatal deaths, intrauterine growth retardation, admission to special care baby unit for conditions associated with intrauterine hypoxia, and low Apgar scores at 1 and 5 min. The report of the CTG was made available to the clinician in 144 patients and withheld in 156 patients. With the report available, significantly more patients were allowed to continue their antenatal care as out-patients, and significantly more antenatal in-patients were allowed home. There were no other significant differences in management, or outcome in the two groups. To estimate the effectiveness of intrapartum fetal monitoring by cardiotocography plus ST analysis using a strict protocol for performance of fetal blood sampling.
                We performed a multicenter randomized trial among laboring women with a high-risk singleton pregnancy in cephalic presentation beyond 36 weeks of gestation. Participants were assigned to monitoring by cardiotocography with ST analysis (index) or cardiotocography only (control). Primary outcome was metabolic acidosis, defined as an umbilical cord artery pH below 7.05 combined with a base deficit calculated in the extracellular fluid compartment above 12 mmol/L. Secondary outcomes were metabolic acidosis in blood, operative deliveries, Apgar scores, neonatal admissions, and hypoxic-ischemic encephalopathy.
                We randomly assigned 5,681 women to the two groups (2,832 index, 2,849 control). The fetal blood sampling rate was 10.6% in the index compared with 20.4% in the control group (relative risk 0.52; 95% [CI] 0.46-0.59). The primary outcome occurred 0.7% in the index compared with 1.1% in the control group (relative risk 0.70; 95% CI 0.38-1.28; number needed to treat 252). Using metabolic acidosis calculated in blood, these rates were 1.6% and 2.6%, respectively (relative risk 0.63; 95% CI 0.42-0.94; number needed to treat 100). The number of operative deliveries, low Apgar scores, neonatal admissions, and newborns with hypoxic-ischemic encephalopathy was comparable in both groups.
                Intrapartum monitoring by cardiotocography combined with ST analysis does not significantly reduce the incidence of metabolic acidosis calculated in the extracellular fluid compartment. It does reduce the incidence of metabolic acidosis calculated in blood and the need for fetal blood sampling without affecting the Apgar score, neonatal admissions, hypoxic-ischemic encephalopathy, or operative deliveries.
                I. The value of routine regular antenatal cardiotocography (CTG) in the management of high-risk pregnancy was assessed in a prospective randomized controlled study of 353 patients. All patients had a weekly CTG trace during the last 6 weeks of pregnancy and according to the random allocation the tracings were concealed from, or available to, the clinicians. Other methods of assessing fetal welfare were available to both groups. There was no significant difference between the concealed and revealed groups in the timing and mode of delivery, birthweights, Apgar score and neonatal morbidity. No apparent effect from the routine use of antenatal CTG in high-risk pregnancy was shown. Previous studies indicate that analysis of the ST waveform of the fetal electrocardiogram provides information on the fetal response to hypoxia. We did a multicentre randomised controlled trial to test the hypothesis that intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis results in an improved perinatal outcome compared with cardiotocography alone.
                At three Swedish labour wards, 4966 women with term fetuses in the cephalic presentation entered the trial during labour after a clinical decision had been made to apply a fetal scalp electrode for internal cardiotocography. They were randomly assigned monitoring with cardiotocography plus ST analysis (CTG+ST group) or cardiotocography only (CTG group). The main outcome measure was rate of umbilical-artery metabolic acidosis (pH <7.05 and base deficit >12 mmol/L). Secondary outcomes included operative delivery for fetal distress. Results were first analysed according to intention to treat, and secondly after exclusion of cases with severe malformations or with inadequate monitoring.
                The CTG+ST group showed significantly lower rates of umbilical-artery metabolic acidosis than the cardiotocography group (15 of 2159 [0.7%] vs 31 of 2079 [2%], relative risk 0.47 [95% CI 0.25-0.86], p=0.02) and of operative delivery for fetal distress (193 of 2519 [8%] vs 227 of 2447 [9%], 0.83 [0.69-0.99], p=0.047) when all cases were included according to intention to treat. The differences were more pronounced after exclusion of 291 in the CTG+ST group and 283 in the CTG group with malformations or inadequate recording.
                Intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis increases the ability of obstetricians to identify fetal hypoxia and to intervene more appropriately, resulting in an improved perinatal outcome. To examine whether intrapartum monitoring by means of automatic ST analysis (STAN) of fetal electrocardiography could reduce the rate of neonatal acidemia and the rate of operative intervention during labour, compared with monitoring by means of cardiotocography (CTG).
                Randomised controlled trial.
                Labour ward in tertiary-level university hospital.
                A total of 1483 women in active labour with singleton term fetus in cephalic presentation.
                Women were randomly assigned to be monitored either by STAN or by CTG. Fetal blood sampling (FBS) was optional in both groups.
                Neonatal acidemia (umbilical artery pH <7.10), neonatal metabolic acidosis (umbilical artery pH <7.05 and base excess <-12 mmol/l) and operative interventions: caesarean section rate, vacuum outlet (VO) rate and FBS rate.
                There were no statistically significant differences between the STAN group and CTG group in the incidence of neonatal acidemia (5.8 versus 4.7%) or metabolic acidosis (1.7 versus 0.7%). The caesarean section rate (6.4 versus 4.7%) and the VO rate (9.5 versus 10.7%) were also similar in the STAN and CTG groups. The incidence of FBS was lower (P < 0.001) in the STAN group (7.0%) than in the CTG group (15.6%).
                Intrapartum fetal monitoring by means of automatic STAN did not improve the neonatal outcome or decrease the caesarean section rate. However, the need for FBS during labour was lower in the STAN group. To compare the efficacies of non-nutritive sucking and glucose solution as pain-relief interventions for neonates undergoing a venipuncture procedure.
                Neonates may be subjected to painful procedures. The individual efficacies of non-nutritive sucking or oral glucose solution used alone on pain-relief for neonates still remain controversial.
                A randomised, parallel-group controlled trial was designed.
                A total of 105 neonates were randomly assigned to one of the three groups: non-nutritive sucking, glucose solution, or control group. When a neonate underwent a venipuncture during a newborn screening test, his/her pain manifestations were videotaped and subsequently measured using the Neonatal Infant Pain Scale. Both the stability analysis and the analysis of repeated relationships were performed by generalised estimating equations.
                The level of pain was regressed over the study variables (time and group) and covariate (gestational age). Both the non-nutritive sucking and glucose solution groups had significantly lower pain scores than the control group during the venipuncture and recovery phases. Furthermore, non-nutritive sucking seemed to be more effective than glucose solution.
                Nurses can use a pain assessment tool and the pain-relief intervention to improve the quality of neonatal care in clinical practice. This study indicates that either non-nutritive sucking or glucose solution can effectively decrease the level of pain.
                If a painful procedure on neonates is inevitable, simple, convenient and effective pain-relief methods such as non-nutritive sucking or glucose solution can be provided alone. Based on a neonate's condition, nurses can provide 2 ml of 25% glucose solution through a syringe for a breastfeeding infant before an invasive procedure if nipple confusion is the concern. Admission cardiotocography is widely used to identify pregnancies that might benefit from continuous electronic fetal monitoring in labour. We aimed to compare the effect on neonatal outcome of admission cardiotocography versus intermittent auscultation of the fetal heart rate.
                8580 women admitted to the delivery ward of a Dublin teaching hospital who were at low risk of fetal distress in labour were randomly assigned admission cardiotocography (20 min) or the unit's usual care (intermittent auscultation only, with continuous cardiotocography only if clinically indicated). The primary outcome was moderate to severe neonatal morbidity, or perinatal mortality in the absence of a major congenital malformation. Analyses were by intention to treat.
                44 (1.0%) women assigned admission cardiotocography did not undergo the procedure; 15 (0.4%) assigned usual care had admission cardiotocography. The primary endpoint occurred in 56 (1.3%) of 4298 women assigned admission cardiotocography and 55 (1.3%) of 4282 in the usual-care group (relative risk 1.01; 95% CI 0.70-1.47). Other indices of neonatal morbidity also showed no differences. Despite an increase in use of continuous cardiotocography (1.39; 1.33-1.45) and fetal blood sampling (1.30; 1.14-1.47) with admission cardiotocography, there were no significant differences in the rates of caesarean delivery (1.13; 0.92-1.40), instrumental delivery (1.03; 0.92-1.16), or episiotomy (1.06; 0.99-1.13).
                Routine use of cardiotocography for 20 min on admission to the delivery ward does not improve neonatal outcome. No significant increase in operative delivery was apparent, probably because of liberal use of fetal blood sampling.
Antenatal maternal glucose administration has not been shown to reduce non-reactive cardiotocography. More trials are needed to further substantiate this and to determine not only the optimum dose, but also to evaluate the efficacy, predictive reliability, safety and perinatal outcome of glucose administration in conjunction with cardiotocography and also other tests of fetal wellbeing.