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And now?

And now?. And now?. alleviation of cause diagnostic intervention Pulse oximetry Scalp blood ST analysis immediate delivery. Before labor. Before term. Second twin. Term, in labor. Fetal intensive care unit. surrogate standard historical only in teaching hospitals.

judithbishop
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And now?

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  1. And now?

  2. And now? • alleviation of cause • diagnostic intervention • Pulse oximetry • Scalp blood • ST analysis • immediate delivery

  3. Before labor

  4. Before term

  5. Second twin

  6. Term, in labor

  7. Fetal intensive care unit

  8. surrogate standard • historical • only in teaching hospitals

  9. T. Murphy Goodwin et al. 1994

  10. reliability problem • Garite 2000, Kuhnert 2004, Klauser 2005, East 2006, Bloom 2006 • unfavorable (limited support) Cochrane review 2007 • operative delivery rate unchanged

  11. Westgate 1993 • Amer-Wahlin 2001 • Ojala 2006 • favorable (some support) Cochrane review (2006) • FDA approval • Vayssière 2007 • Large Dutch trial

  12. Problems with STAN* The management guidelines are primarily based on the interpretation of the FHR pattern and will therefore not be of assistance if CTG interpretation is poor. False-negative cases are a reality. STAN events are common even in women with normal CTG patterns. *Ingemarsson & Westgren, 2007

  13. Sensitivity for low cord pH

  14. Sequentieel screenen! De vereiste dat, nadat een eerste test (CTG) afwijkend is gebleken, ook nog een tweede test (SpO2 of STAN) afwijkend moet zijn alvorens te interveniëren, leidt er noodzakelijkerwijze toe dat de sensitiviteit (voor foetale nood) van de overall strategie afneemt

  15. toekomst • Analyse van: • ST • STV • PR

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