We conducted an individual patient data metaanalysis using data from 4 randomized trials, which enabled us to account for missing data and investigate relevant subgroups. The primary outcome was metabolic acidosis, which was defined as an umbilical cord-artery pH <7.05 and a base deficit that had been calculated in the extra cellular fluid compartment >12 mmol/L. We performed 8 explanatory subgroup analyses for 8 different endpoints.
We analyzed data from 12,987 women and their newborn infants. Metabolic acidosis was present in 57 women (0.9 % ) in the EFM + ST group and 73 women (1.1 % ) in the EFM alone group (relative risk [RR], 0.76; 95 % CI, 0.53-1.10). Compared with EFM alone, the use of EFM + ST resulted in a reduction in the frequency of instrumental vaginal deliveries (RR, 0.90; 95 % CI, 0.83-0.99) and fetal blood samples (RR, 0.49; 95 % CI, 0.44-0.55). Cesarean delivery rates were comparable between both groups (RR, 0.99; 95 % CI, 0.91-1.09). Subgroup analyses showed that EFM + ST resulted in fewer admissions to a neonatal intensive care unit for women with a duration of pregnancy of >41 weeks (RR, 0.61; 95 % CI, 0.39-0.95).
EFM + ST does not reduce the risk of metabolic acidosis, but it does reduce the need for instrumental vaginal deliveries and fetal blood sampling.