O147 Impact of ‘Human Worm’ on Serious Adverse Incidents in Obstetric Practice

Coroyannakis, Christina; Chandraharan, Edwin

doi:10.1016/s0020-7292(12)60577-3

Cited by 3 publications

(1 citation statement)

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“…Analysis of cases with neonatal encephalopathy despite the use of STAN monitoring, revealed that human error was responsible for 13 out of 14 cases. These included: error in CTG interpretation, failures in considering the wider clinical picture such as the presence of meconium, chorioamnionitis, failure to progress in labor as well as injudicious use of oxytocin infusion and delays in intervention (38). It seems to be human error that blunts the effectiveness of the STAN technology.…”

Section: Stan and Fbsmentioning

confidence: 99%

Scalp Blood Lactate for Intrapartum Assessment of Fetal Metabolic Acidosis

Heinis

Spaanderman

Gunnewiek

et al. 2012

Obstetric Anesthesia Digest

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P erinatal death, maternal morbidity, and maternal mortality are all complications of preeclampsia. Women who have preeclampsia have higher rates of emergency cesarean sections, preterm births, and symptoms of posttraumatic stress after delivery. The authors of this study hypothesized that the physical and psychological consequences of preeclampsia might affect postpartum health-related quality of life, principally in women who experienced severe preeclampsia. Therefore, they measured quality of life parameters among postpartum women who had preeclampsia.Women who participated in the study were given the RAND 36-item Short Form Health Survey, a self-administered health-related quality of life questionnaire, at 6 and 12 weeks postpartum. The 3 study objectives of the questionnaire were to: (1) describe changes in all domains of health-related quality of life between 6 and 12 weeks postpartum after mild and severe preeclampsia; (2) assess the difference in health-related quality of life after mild and severe preeclampsia and; (3) determine the contributing factors of these differences in health-related quality of life. The study population was composed of 127 women who answered the questionnaires at both 6 and 12 weeks. Cohen's effect sizes "d " were estimated by dividing the difference in mean scores between subgroups by the largest standard deviation. Cohen's guidelines suggest 0.2rd < 0.5 indicates a "small effect"; 0.5 < d < 0.8 a "medium effect"; and dZ0.8 a "large effect." In general, d = 0.5 can be considered as a threshold for a "minimally important difference."Overall, 74% of the participants experienced severe preeclampsia, 79% were primiparous and the mean age was 31 ± 5 years. The women who experienced severe preeclampsia were more often younger (P < 0.01), more likely to have a cesarean section (P < 0.001), delivered at a lower gestational age (P < 0.001), delivered a lower birthweight infant (P < 0.001), and had infants who were more likely to be admitted to the neonatal intensive care unit (ICU) (P < 0.001) for longer periods of time (P < 0.001) compared with women who were not severely preeclamptic. These women were also more likely to be admitted to the obstetric ICU (55%), experience perinatal death (6%), and have multiple gestations (11%). None of the women who had mild preeclampsia were admitted to the ICU, experienced perinatal death, or had multiple gestations.Mean Short Form-36 scores were lower at 6 weeks postpartum in the study participants, especially the vitality, social functioning, and physical component scale scores (all scores P < 0.001 and dZ0.8). The scores on most of the physical scales remained low at 12 weeks postpartum but the mental scales did not. Health-related quality of life improved from 6 to 12 weeks in women who experienced mild preeclampsia for physical, vitality, and social functioning (all P < 0.001 and dZ0.5), and the physical, body pain, and social functioning scales improved for women who experienced severe preeclampsia (all P < 0.001 and dZ0.8). Women with severe ...

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Section: Stan and Fbsmentioning

confidence: 99%

Scalp Blood Lactate for Intrapartum Assessment of Fetal Metabolic Acidosis

Heinis

Spaanderman

Gunnewiek

et al. 2012

Obstetric Anesthesia Digest

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Umbilical Cord Prolapse

Pereira

Chandraharan

2018

Medicolegal Issues in Obstetrics and Gynaecology

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Foetal electrocardiograph (ST-analyser or STAN) for intrapartum foetal heart rate monitoring: a friend or a foe?

Chandraharan

2017

The Journal of Maternal-Fetal & Neonatal Medicine

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Cardiotocograph (CTG) is associated with a high false positive rate of up to 60% which may increase the risk of unnecessary intrapartum interventions (emergency caesarean sections or operative vaginal deliveries) without any significant benefits. A recent study on variation of caesarean section rates in England has concluded that there was a very wide variation even in the adjusted rates of caesarean section from 14.9% to 32.1%. Cochrane Systematic Reviews have concluded that the use of FBS does not reduce caesarean section rate or any pre-specified neonatal outcomes. Fetal ECG (ST-Analyser or STAN) has been used in the clinical practice for more than 20 years. Although, initial randomised controlled trials (RCTs) showed great promise regarding the role of STAN in reducing operative delivery rates (instrumental vaginal births and emergency caesarean sections) and neonatal metabolic acidosis, subsequent studies have questioned the role of STAN in clinical practice. A recent meta-analysis which included six randomised controlled trials (a total of 26,446 women) has concluded that there was a 36% reduction in the rate of neonatal metabolic acidosis. Practising clinicians currently face a dilemma as to whether STAN has a place in contemporary obstetric practice or whether it?s use should be discouraged and discontinued.

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O147 Impact of ‘Human Worm’ on Serious Adverse Incidents in Obstetric Practice

Cited by 3 publications

References 0 publications

Scalp Blood Lactate for Intrapartum Assessment of Fetal Metabolic Acidosis

Scalp Blood Lactate for Intrapartum Assessment of Fetal Metabolic Acidosis

Umbilical Cord Prolapse

Foetal electrocardiograph (ST-analyser or STAN) for intrapartum foetal heart rate monitoring: a friend or a foe?

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