Cadiotocography Combined With ST-analysis Versus Cardiotocography Combined With Scalp-pH

This study has been terminated.
(slow enrollment)
Sponsor:
Collaborator:
ElsassFonden
Information provided by (Responsible Party):
Diana BB Bach, MD, Hvidovre University Hospital
ClinicalTrials.gov Identifier:
NCT01699646
First received: January 10, 2012
Last updated: October 3, 2012
Last verified: October 2012
  Purpose

Hypothesis:

STAN monitoring will reduce the number of interventions because of suspected fetal asphyxia and reduce the number of newborns with metabolic acidosis.

Primary endpoint:

1) Frequency of metabolic acidosis in the two groups, defined by pH in umbilical cord artery < 7.05 and standard base excess <-10.

Secondary endpoints:

  1. Number of intervention (VE and caesarean section) in the two groups
  2. Number of pH measurements in the two groups
  3. Number of neonates admitted to the neonatal department because of suspected asphyxia in the two groups

The aim of fetal surveillance is to identify those fetuses at risk for developing damage in newborn to term or long term damage caused by lack of oxygen during birth process. Approximately 1/10 of all cases of paralysis due to brain damage (cerebral palsy) is believed to be caused by lack of oxygen during birth. These can be avoided if the investigators intervene actively in the birth before damage occurs.

CardioTocoGraphy (CTG = detection of fetal heart rate pattern and maternal uterine contractions via electrodes on the maternal abdomen and fetal scalp) is a widely used method of fetal surveillance. However, it can be difficult to interpret a CTG, and uncertainty in CTG interpretation may therefore lead to increase in the number of deliveries with vacuum suction and caesarean section. Interpretation of CTG can be improved by analyzing the acidity of a blood sample taken from the skin of the fetal scalp. Such a scalp pH analysis shows indirectly the fetus gets enough oxygen. Scalp pH measurement requires expertise and requires repeated measurements if the abnormal heart rate pattern persists. This method is the normal routine at the maternity ward at Hvidovre Hospital / Roskilde County Hospital.

The problem seems to be partially alleviated by using a newly developed method for fetal surveillance called STAN (ST analysis). By STAN continuously recorded both CTG and fetal ECG (electrocardiography = recording of the electrical heart activity). Simultaneously analyzes a portion of the fetal ECG, namely ST-part because hypoxia leads to changes in it. The technique is easy to use, since it only requires one electrode on the fetal scalp that is placed in the same way as in ordinary CTG registration.


Condition Intervention
Metabolic Acidosis of Newborn
Device: Neoventa S 21 ST-ANalysis of fetal heart
Procedure: CTG + FBS

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Cardiotocography Combined With ST-analysis Versus Cardiotocography Combined With Scalp-pH in Deliveries With Abnormal CTG - A Randomised Trial

Further study details as provided by Hvidovre University Hospital:

Primary Outcome Measures:
  • Frequency of metabolic acidosis in the 2 groups, defined by pH < 7,05 and SBE < -10 in the umbilical artery [ Time Frame: within 1 hour ] [ Designated as safety issue: Yes ]
    We will do a minimum 2 year follow-up on the children


Secondary Outcome Measures:
  • Does STAN reduce number of admissions to NICU and/or HIE [ Time Frame: 2 years after termination of study ] [ Designated as safety issue: Yes ]
    Number of neonates admitted to NICU because of suspected asphyxia in the two groups. There will also be a minimun of 2 years of follow-up in these children

  • Does STAN reduce number of interventions in delivery(vacuum or section) [ Time Frame: 1 year after termination of study ] [ Designated as safety issue: Yes ]

Other Outcome Measures:
  • Does ST-ANalysis increase specificity and sensitivity of scalp-pH and vise verce [ Time Frame: 1 year after termination of study ] [ Designated as safety issue: No ]
  • Does STAN reduce number of scalp-pH measurements [ Time Frame: 1 year after termination ] [ Designated as safety issue: Yes ]

Enrollment: 1025
Study Start Date: December 2005
Estimated Study Completion Date: December 2012
Primary Completion Date: January 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: CTG + FBS
intrapartum surveillance with CTG+FBS
Procedure: CTG + FBS
Cardiotocography and fetal blood sampling on/from fetal skalp
Other Name: Cardiotocography and fetal blood sampling (scalp-pH)
Active Comparator: Neoventa S 21 ST-ANalysis of fetal heart
intrapartum surveillance with CTG + STAN
Device: Neoventa S 21 ST-ANalysis of fetal heart
Application of "gold-trace" scalp electrode
Other Name: Cardiotocography and ST-ANalysis

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years to 50 Years
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • intermediate or abnormal CTG and
  • Normal fetal scalp-pH > or = 7,25

Exclusion Criteria:

  • preterminal CTG
  • Fetal arrythmias or A-V block
  • Severe fetal malformations (known)
  • Amnionitis (temp > 38,5 degr. celcius)
  • maternal Hepatitis B/C or HIV
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01699646

Locations
Denmark
Hvidovre Hospital
Copenhagen, Hvidovre, Denmark, 2650
Sponsors and Collaborators
Hvidovre University Hospital
ElsassFonden
Investigators
Study Director: Niels J Secher, prof, MD Copenhagen University, Denmark
  More Information

No publications provided

Responsible Party: Diana BB Bach, MD, MD, Hvidovre University Hospital
ClinicalTrials.gov Identifier: NCT01699646     History of Changes
Other Study ID Numbers: CTG+ST vs CTG +scalp-pH, DK
Study First Received: January 10, 2012
Last Updated: October 3, 2012
Health Authority: Denmark: National Board of Health

Keywords provided by Hvidovre University Hospital:
Intrapartum fetal surveillance
CTG
cardiotocography
STAN
ST-Analysis
metabolic acidosis in umbilical artery
operative delivery

Additional relevant MeSH terms:
Acidosis
Acid-Base Imbalance
Metabolic Diseases

ClinicalTrials.gov processed this record on July 28, 2014