Professor Jacquemyn was the first to introduce STAN in Belgium in 2001, and since this time his department at the University Hospital of Antwerp has been a ‘Centre of Excellence’. Together with the midwives Gisèle Possemiers and Suzy Verbruggen he has trained hundreds of doctors and midwives in the STAN method. The ‘students’ have not just come from the region of Flanders but from the whole of Belgium, from the Netherlands and Luxembourg.
We asked Professor Jacquemyn a few questions about his views on STAN-training and implementation and his ideas for future research in the STAN method. We were also curious to know how he feels to be doctor that never goes on holiday.
Professor Jacquemyn, you are the pioneer of STAN in Belgium. What was it that made you decide to start working with ST Analysis in 2001?
“We tried to introduce STAN in Belgium even before it was commercially available in Belgium. We were already intrigued by the positive results of the method that we read about in publications and heard about at congresses. This was especially interesting for Flanders as we do almost no fetal blood sampling. And there was also a personal component to my interest: I started my scientific career in the field of electro-physiology of the heart, and therefore I had a special interest in applying this knowledge in the obstetric field.”
Together with Gisèle Possemiers and Suzy Verbruggen you have introduced hundreds of colleagues to the STAN method. What do you think are most important in order to achieve a successful clinical implementation of ST Analysis?
“Adequate training in the interpretation of CTG according to the FIGO-criteria and subsequently a correct application of the STAN guidelines is essential to be able to use the STAN method in a successful way. I believe that a ‘Certification-test’ after training can play an important part in the quality control of usage of the STAN method. It is only by giving feedback to the student that you can check if the method has truly been understood and if the guidelines can be applied correctly. For a successful implementation, I also believe that it is very important that you organise case discussions, especially in the up-start phase, where you can discuss the traces and the measures that you have or have not taken in the event of poor outcomes.”
In your labour and delivery ward at the University Hospital you are only using STAN for fetal monitoring. You have three STAN with ST Analysis and two STAN with only CTG. Why did you make this choice?
“We only want to one type of monitor in the whole L&D ward, as this result in a better uniformity of the used equipment. And since we want to use ST Analysis we chose the STAN monitor. We have STAN-CTG monitors without ST Analysis in the observation rooms, and STAN with ST Analysis in the labour rooms. We have the possibility to exchange monitors between rooms, to upgrade when necessary and to integrate with the central monitoring system ‘Mosos’ that we use.”
Recently, a large Dutch randomised controlled trial was published, in which the STAN method was compared to CTG with fetal blood sampling. The results were very positive for STAN. What is the most important ‘take-home-message’ from this study according to you?
“The Dutch study confirmed that when STAN is used there is a reduction of the incidence of metabolic acidosis. Dependent on the method of calculation, this reduction is between 30 and 44%. The study also showed that fetal blood sampling can be used considerably less often without compromising fetal outcome.
The importance of this study is to be found in the conclusion, that in those countries where fetal blood sampling is still frequently used, a considerable amount of these fetal blood samplings can be avoided in a safe manner.”
In which areas of research and development do you see the most need for enhancement in order to make STAN and ST Analysis even more useful?
“The most important problem that needs to be solved is the sometimes difficult interpretation of the CTG, and the classification into the correct FIGO-class, especially when you have questionable cases between suboptimal and abnormal CTG. The use of a computerized or automated system that can classify the CTG, of which several versions are actually being developed, will probably further enhance the usefulness of the system. Another remaining issue for STAN and ST Analysis is when you do not or cannot perform fetal blood sampling. There are also sometimes technical problems of signal loss and it would of course be very interesting to have more information about the use of ST Analysis in pregnancies before 36 weeks.”
You are a member of the organisation Medics without Vacation. Can you tell us about the work that you do there?
“Medics without Vacation is a completely different aspect of my life. Whereas fetal monitoring and ST Analysis has to do with very sophisticated equipment and in fact, improve outcome for mothers and children only for a limited part of the population, Medics without Vacation goes back to fundamental care and offers very basic care during a short period to a larger part of the population.
Medics without Vacation offer you the possibility to pass on your own surgical and technical competence gained in Europe to less developed countries and to adapt it to the local context. The main purpose of the organisation is to present techniques to local doctors with which they can help their patients in the best possible way. One example is the tragedy of the vesico-vaginal fistula in African women. By teaching the correct caesarean section technique and by practising techniques to repair the fistula together with local doctors we hope to further reduce the problem.
I would like to ask all interested doctors, nurses and midwives – we always need more – to at the website www.azv.be. There you can see what Medics without Vacation does, and what you yourself can do to help. You can also make a contribution to the account number that you will find on the website.”
Yves Jacquemyn is a clinical professor at the University Hospital of Antwerp and a member of the international STAN expert group.