A nationwide descriptive study of obstetric claims for compensation in Norway.

“Increased training in fetal monitoring and obstetric emergency situations are recommended to decrease the obstetric compensation claims”
In this article reasons for substandard care in obstetric compensation claims are discussed.
Fetal asphyxia is the most common reason for compensation, resulting in large financial expenses to society. Human errors contribute to inadequate health care in 92 % of obstetric compensation claims, although underlying system errors may also be present.
Fetal birth asphyxia, anal sphincter tear and infection are the most common …

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Understanding cardiotocographic patterns associated with intrapartum fetal hypoxia and neurological injury

“If there are more focus on pattern recognition and pathophysiology it all becomes more evident.”
Obstetricians and midwives have been trained to focus on morphological appearances of fetal decelerations rather than to understand the underlying psychological mechanisms, how the fetus compensates and defends itself. In that way original interpretations of fetal heart patterns equated decelerations to fetal distress and mandated operative interventions. Since then consequently operative interventions are undertaken to rescue fetuses that display benign signs of fetal heart rate …

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Poster at ECIC: Assessement of an e-Learning program of FHR monitoring. A randomised study

A French study shows that training in CTG interpretation using an e-learning program improves the performance of obstetrical staff.  A poster of this study was presented at the European Congress on Intrapartum Care (ECIC) in Amsterdam this spring.

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Renewed meta-analysis: Further support for ST Analysis

The objective of this meta-analysis was to investigate the additional effect of ST Analysis as an adjunct to electronic fetal monitoring. In order to overcome the shortcomings of conventional meta-analysis that uses aggregated data, the present analysis used individual participant data to allow for a more thorough investigation by taking all information into account, including accounting for missing data.
Only four of the five published randomised controlled trials (RCT) were included in the analysis. The first RCT by Westgate …

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Fetal ECG waveform – helps differentiating maternal from fetal heart rate

The objective of this retrospective study was to investigate the incidence of heart rate accelerations coinciding with contractions during the second stage of labour when monitored either with abdominal ultrasound (external) or scalp electrode (internal).

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Five years of ST Analysis usage in Bergen – a quality improvement study

Data from five years of clinical usage of ST Analysis and Stan at the Labour and Delivery ward at Haukeland University Hospital in Bergen, Norway is reported in this prospective observational study. The study was defined as a project of quality improvement, and included a total of 22,475women selected for vaginal delivery.

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Strict adherence to Stan Guidelines leads to improved outcome

In this sub-analysis of the Dutch randomised trial it is shown that cases with adverse outcome in the index group (CTG+ST analysis) could have been avoided by stricter adherence to Stan guidelines. Improved CTG interpretation and timing of fetal blood sampling could have led to better outcomes in the control group.

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Poster at SMFM: Significantly improved outcomes over 10 years of STAN usage in Turku

Dr. Timonen from Turku University Hospital, Finland presented a poster with their experience of ST Analysis at the recent Society for Maternal- Fetal Medicine (SMFM) congress in Dallas USA. The rate of metabolic acidosis was reduced by 79% when the first four years of ST Analysis usage were compared to the six following years in patients monitored with CTG+ST. During the same period the number of fetal scalp blood measurements was substantially reduced as well as the rate of total cesarean …

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No risk associated with high baseline T/QRS ratio

In the European Stan Expert meeting in 2009, the interpretation of a high baseline T/QRS ratio at the start of a registration was discussed since some cases with high baseline T/QRS followed by metabolic acidosis had been encountered. The baseline T/QRS is the absolute value of the T/QRS ratio at the start of a Stan recording, and is currently only used for comparison with later changes indicating a rise in the T-wave of the fetal ECG.

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Meta-Analysis concludes benefits of ST Analysis

The objective of this meta-analysis, which includes five randomised trials (RCT) and 15,352 patients, was to compare the effects of adding ST Analysis to conventional intrapartum CTG. The included RCT’s evaluated singleton term pregnancies in cephalic presentation and the meta-analysis was performed on results for metabolic acidosis, fetal blood sampling, mode of delivery, Apgar score and neonatal care. For three of the studies, published corrected data were used and the meta-analysis could be performed on all data according to the intention-to-treat principle.

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