A randomised controlled trial of pregnant women being monitored during labour with ST analysis monitoring and cardiotocography, compared to being monitored with cardiotocography alone, in order to reduce caesarean section whilst still having comparable outcomes for the baby.

Arm 1; Cardiotocographic monitoring only, using a external fetal doppler heart rate transducer strapped around the maternal waist or a metal scalp clip attached to the babies scalp, along with an external tocodynometer strapped to the mothers pregnant abdomen. These transducers and pressure monitors are attached to an electronic fetal monitor (CTG machine), which produces a graphic correlation of fetal heart rate to uterine activity. Trained medical and midwifery staff interpret these temporal correlations according to established guidelines. Arm 2: ST analysis (STan) fetal monitoring and cardiotocographic monitoring, using a specialised machine (Neovena STan monitor) that combines cardiotocographic monitoring (as above) with an electrocardiographic (ECG) recording of fetal cardiac activity, requiring a metal scalp clip attached to the unborn babies scalp. This monitoring is only commenced once the cervix is dilated enough and the membranes are ruptured, allowing the clip to be attached. A computerised analysis of the fetal ECG ST segment by the STan monitor provides additional information that is interpreted by guidelines developed by Neoventa by trained medical and midwifery staff. The randomisation is performed when the decision is made during labour by medical or midwifery staff that electronic fetal monitoring is necessary, and the monitoring is continued until delivery of the baby.