Fetal blood sampling in addition to intrapartum ST-analysis of the fetal electrocardiogram: evaluation of the recommendations in the Dutch STAN â trial JH Becker, a MEMH Westerhuis, a K Sterrenburg, a ESA van den Akker, b E van Beek, c AC Bolte, d TJHM van Dessel, e AP Drogtrop, e HP van Geijn, d GCM Graziosi, c JMM van Lith, f BWJ Mol, g KGM Moons, h JG Nijhuis, i SG Oei, j HP Oosterbaan, k MM Porath, j RJP Rijnders, g NWE Schuitemaker, l LDE Wijnberger, f C Willekes, i GHA Visser, a A Kwee a a Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht b Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam c Department of Obstetrics and Gynaecology, St Antonius Hospital, Nieuwegein d Department of Obstetrics and Gynaecology, Free University Medical Centre, Amsterdam e Department of Obstetrics and Gynaecology, TweeSteden Hospital, Tilburg f Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden g Department of Obstetrics and Gynaecology, Amsterdam Medical Centre, Amsterdam h Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht i Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht j Department of Obstetrics and Gynaecology, Ma ´xima Medical Centre, Veldhoven k Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, ‘s Hertogenbosch and l Department of Obstetrics and Gynaecology, Diakonnesenhuis, Utrecht, the Netherlands Correspondence: Dr JH Becker, Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Location WKZ, KE 04.123.1, PO Box 85090, 3508 AB Utrecht, the Netherlands. Email j.h.becker@umcutrecht.nl Accepted 24 March 2011. Published Online 14 June 2011. Objectives To evaluate the recommendations for additional fetal blood sampling (FBS) when using ST-analysis of the fetal electrocardiogram. Design Prospective cohort study. Setting Three academic and six non-academic teaching hospitals in the Netherlands. Population Labouring women with a high-risk singleton pregnancy in cephalic position beyond 36 weeks of gestation. Methods In labouring women allocated to the STAN Ò arm of a previously published randomised controlled trial who underwent one or more FBS during delivery, we assessed whether FBS was performed according to the trial protocol and how fetal acidosis, defined as an FBS pH < 7.20, was related to ST-waveform analysis. Main outcome measures The number of FBS showing fetal acidosis, related to the different STAN Ò criteria where additional FBS is recommended. Results Among 2827 women monitored with STAN Ò , 297 underwent FBS, of whom 171 (57.6%) were performed according to the predefined criteria and 126 were performed in absence of these criteria. In the first group, rates of fetal acidosis (pH < 7.20) were two of 18, none of nine, 12 of 111 and three of 33 when FBS was taken for abnormal cardiotocogram (CTG) at the start, intermediary CTG at the start, abnormal CTG >60 minutes, and poor electrocardiogram quality, respectively. When the predefined criteria were not met and ST- analysis showed no ST-events, only two incidents of fetal acidosis were seen. Conclusions The performance of FBS is valuable in the advised STAN Ò criteria. When these criteria are not met, performance of FBS does not seem helpful in the detection of fetal acidosis. Keywords Fetal blood sampling, fetal electrocardiogram, intrapar- tum monitoring, STAN Ò , ST-analysis. Please cite this paper as: Becker J, Westerhuis M, Sterrenburg K, van den Akker E, van Beek E, Bolte A, van Dessel T, Drogtrop A, van Geijn H, Graziosi G, van Lith J, Mol B, Moons K, Nijhuis J, Oei S, Oosterbaan H, Porath M, Rijnders R, Schuitemaker N, Wijnberger L, Willekes C, Visser G, Kwee A. Fetal blood sampling in addition to intrapartum ST-analysis of the fetal electrocardiogram: evaluation of the recommendations in the Dutch STAN Ò trial. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.03027.x. ª 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology ª 2011 RCOG 1 DOI: 10.1111/j.1471-0528.2011.03027.x www.bjog.org