The document discusses the use of fetal heart rate monitoring (EFM) during labor and delivery. While EFM reduced perinatal mortality, it also increased rates of surgical intervention. The addition of ST analysis (STAN) to EFM provides more precise information about the fetal state by detecting abnormalities in the fetal ECG. Large randomized controlled trials in the UK and Sweden found that combining EFM with STAN significantly reduced fetal metabolic acidosis and operative delivery rates, and decreased rates of neonatal encephalopathy. STAN allows for better grading of fetal condition between the extremes of very healthy and very sick.

1. Presented By: Chukwuma I. Onyeije, M.D. Atlanta Perinatal Associates Clinical Associate Professor, Morehouse School of Medicine

8. The 1970s CLINICAL OBSTETRICS AND GYNECOLOGY Volume 54, Number 1, 56–65 r 2011, Lippincott Williams & Wilkins

10. Intrapartum EFM associated with decreased perinatal mortality due to fetal hypoxia but also with higher rates of surgical intervention for suspected fetal distress. Vintzeleos et al, Obstet Gynecol. 1993 Jun;81(6):899-907.

11. Compared to Auscultation, EFM results in higher operative delivery rates without significant lowering of perinatal mortality.

12. Conclusion: Auscultation…. The winner!

37. T:QRS Ratio   EVENT LOG  AVERAGE T:QRS  ST ALRETS

42. FHR CLASSIFICATION BASELINE FHR VARIABILITY DECELERTIONS GR EEN 110 - 160 MODERATE (+)ACCELERATIONS EARLY VARIABLE (LESS THAN 60 x 60) YELLOW BRADY <110 TACHY > 160 > 150 WITH MINIMAL VARIABILITY MINIMAL FOR > 40 MIN MARKED FOR > 40 MIN VARIABLE GREATER THAN 60 x 60 RECURRENT LATE PROLONGED RED SINUSOIDAL OR ABSENT VARIABILITY REGARDLESS OF FHR PATTERN

43. STAN’s FHR Clinical Management Protocol FHR CLASSIFICATION NO ST EVENTS ST EVENTS PRESENT GR EEN EXPECTANT MANAGEMENT CONTINUED OBSERVATION YELLOW EXPECTANT MANAGEMENT DIRECT PHYSICIAN ASSESSMENT OF FETAL STATE IF > 60 MINUTES DIRECT PHYSICIAN ASSESSMENT INTRAUTERINE RESUSCITATION EXPEDITED DELIVERY IF NO IMPROVEMENT RED EXPEDITIOUS DELIVERY / RESUSCITATION (?)

46. UNITED KINGDOM: 1993 SWEDEN: 2001