The clinical and economic efficiency of direct electrocardiography with ST-segment analysis in the evaluation of fetal status

Objective. To compare the clinical and economic efficiency of traditional cardiotocography (CTG) and its combined use with direct fetal electrocardiography (ECG) and automatic analysis of ST-segment changes for the early detection of intranatal fetal hypoxia. Subjects and methods. A prospective study of the course of pregnancy and delivery was conducted in 480 women at the V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology. The authors designed a decisionmaking model (TreeAge Pro Inc), by which a cost-effectiveness analysis was used to compare 2 strategies: CTG and ECG in combination with direct ECG (with automatic ST-segment analysis) to determine the minimum cost of the birth of a baby without asphyxia. Results. With the use of traditional fetal CTG at birth, the chance of giving birth to a baby without severe asphyxia was 91% versus 97% with that of a combination of CTG and ECG (that was 70 and 82% during cesarean section and 96 and 98% during vaginal delivery, respectively). The mean cost of birth per healthy baby (without severe asphyxia and consideration of expenses on neonatal management and rehabilitation) was 54,645.78 and 42,903/72 rubles with the use of CTG and CTG + ECG, respectively. Conclusion. CTG in combination with direct fetal ECG with automatic ST-segment analysis makes it possible to effectively and timely monitor fetal status during an active delivery stage. The use of this procedure can substantially reduce the cost of labor induction.

STAN, cardiotocography, direct electrocar diography, ST-segment analysis (STAN), fetal hypoxia, clinical and economic analysis