Module 7 - TOG - ST Analysis for Intrapartum Foetal Monitoring

Question 1

What is needed to be applied before STAN can be started?

Answer 1

FSE
CTG (normal)

Question 2

What is the principle of STAN?

Answer 2

To use foetal ECG to detect myocardial ischemia.
Compares each 30 foetal heart beats to the last 30 beats to look for changes in the ST/QRS complexes.

Question 3

What changes can STAN detect?

Answer 3

1. Episodic T/QRS Rise (<10 mins)
2. Baseline T/QRS Rise (>10 mins)
3. Biphasic ST (downward sloping ST)

Question 4

What CTG interpretation does STAN use?

Answer 4

FIGO CTG classification
(4 classifications:
- normal
- intermediary
- abnormal
- preterminal).

Question 5

Who can STAN be started in?

Answer 5

Singleton pregnancies
Cephalic
>36/40
With ruptured membranes (and FSE applied)

Question 6

What foetal outcomes does STAN alter?

Answer 6

Reduces FBS and instrumental rates.

No difference in LSCS rates or APGAR scores, foetal acidaemia or HIE rates.

Question 7

Can STAN replace CTG?

Answer 7

No, STAN can only be used as an adjunct to CTG.

Question 8

When is STAN not appropriate to be started?

Answer 8

• multiple pregnancy
• abnormal CTG
• breech (although breech setting now available)
• known foetal cardiac abnormality
• LOC >4 mins (restart STAN)
• chorioamnionitis
• ischemia or hypoxia that has already developed.