Évaluation de la forme simplifiée de la classification du rythme cardiaque fœtal proposée dans le cadre des recommandations pour la pratique clinique « surveillance du travail »

Fetal physiology cardiotocography training, a regional evaluation

INTRODUCTION

Cardiotocography (CTG) has its limits in detecting fetal acidosis and intrapartum asphyxia. Our aim was to evaluate a CTG training programme based on fetal physiology in the Mediterranean perinatal network.

METHODS

Professionals from 41 maternity units of the Mediterranean network were invited to participate in a CTG masterclass based on fetal physiology in March 2019 and October 2019. They were asked to react to three practical cases by a physiological approach before the training course (T0), one month after (T1) and six to seven months after (T2). The mean scores were compared by using a mixed model including lapse of time to evaluation, profession of participants and level of the maternity unit as fixed effects.

RESULTS

A total of 248 professionals from 32 maternity units finally participated in the organizational audit. By using a mixed model, we found a significant improvement of the mean score at T1=6.44/10 compared to T0=4.97/10 (p<0.0001), and a significant improvement of the mean score obtained at T2=6.17/10 compared to T0 (p<0.0001). T2 scores were not significantly different from T1 scores (p=0.143).

DISCUSSION

A CTG training programme based on fetal physiology showed a significant improvement in the professionals' interpretation of CTG at short term and stable results at long term. Continuing medical education could help maintain and improve knowledge to ensure neonatal safety.

[Retrospective evaluation of relevance of care in the management of presumed benign ovarian tumors]

INTRODUCTION

The relevance of care is defined by the right act, for the right patient, at the right time. We were interested in the relevance of the management of presumed benign ovarian tumors before and after the release of the CNGOF guidelines 2013 (French guidelines).

METHODS

This is a retrospective observational study conducted at the University Hospital in Strasburg France from 01/01/2013 to 31/12/2017 including all patients treated for a presumed benign ovarian cyst. We were interested in the diagnostic approach: relevance of the prescribed imaging and the use of CA 125 dosage, in the therapeutic approach: the relevance of the technique used as well as the relevance of the surgical indication. We compared our practices between 2013 and 2017 for these same items.

RESULTS

We included 682 cysts for 621 patients, the imaging performed was relevant in 55% of cases, not relevant but justified in 25% and irrelevant in 20%. The CA 125 assay or its absence of assay was relevant in 84% of cases. The surgical technique was relevant in 67% of cases and not relevant but justified in 29%. With a significant improvement 7.1% in 2013 of irrelevant against 0.9% for the year 2017. The surgical indication was relevant in 72% of cases, not relevant but justified in 20% and irrelevant in 2.7%.

CONCLUSIONS

The analysis of the relevance of care allows an evaluation of our practices. Professional recommendations can have an impact on the quality of care.

[Per-partum risk factors of neonatal acidemia in planned vaginal delivery for fetuses in breech presentation]

OBJECTIVES

Delivery mode of term breech presentation is debated because of higher rate of neonatal acidosis (pH<7.15) in planned vaginal delivery than in planned caesarean section. The objective was to evaluate per-partum risk factors of neonatal acidosis in vaginal delivery for podalic fetuses.

METHODS

It was a single-centre, case-control retrospective study that included planned vaginal delivery in singleton term breech presentation between 2012 and 2016. The "case" group defined by neonatal pH≤7.10 and the "control" group defined by neonatal pH≥7.20 were matched. The maternal, labor, and neonatal characteristics were noted.

RESULTS

One hundred and thirty-two patients were included: each of 44 patients in "case" group, has been matched according to breech type (legs position) to 2 patients in the "control" group, so 88. In multivariate analysis, significant risk factors identified were oxytocin use [ORa=5.663 (95% CI=1.844-17.397)], "high risk" fetal heart rate (FHR) abnormalities according to FIGO classification [ORa=10.997 (95% CI=1.864-64.866)] and FHR abnormalities during expulsion, Melchior 2 [ORa=8.088 (95% CI=1.192-54.875)] and Melchior 4 [ORa=12.705 (95% CI=1.157-139.541)].

CONCLUSIONS

These risk factors of neonatal acidemia have to be known to improve the labor management in case of breech planned vaginal delivery.

Fetal heart rate classification in routine use: Do your prefer a 3-tier or a 5-tier classification?

OBJECTIVE

To assess the current use of a five-tier fetal heart rate (FHR) classification system (National College of French Obstetricians and Gynecologists, CNGOF, 2007) and of a three-tier system (Federation International of Gynecology and Obstetrics, FIGO, 2015).

MATERIALS AND METHODS

This was a single-center prospective study conducted in April 2016. Midwives were asked to classify FHR hourly during their patients' labors according to two classification systems (CNGOF and FIGO). For each system the midwives rated from 0 to 10 the following elements after delivery: ease of FHR classification, the memorization of the classification, access to routine use, and help with the decision of a second-line examination. Finally, they had to choose which classification system seemed most helpful in their clinical practice.

RESULTS

Forty-six patients were included in the study. The median score for the ease of FHR classification according to the CNGOF system was 7, versus 8 according to the FIGO system (p<0.05). The median score for the ease of remembering the classification was 4 for CNGOF versus 8 for FIGO (p<0.05). The FIGO classification system was considered the easiest to use in 76% of cases and the CNGOF system was the most helpful in 61% of cases. The CNGOF system was seen as a help in deciding on a second-line examination in 70% of cases and the FIGO was a help in 63% of cases.

CONCLUSION

The three-tier FIGO classification system seemed easier to use but the five-tier CNGOF classification system was more helpful. The choice of which system to use should be discussed within each medical team.