Using technology for better obstetric decision making
A wonderful feature from one of VitalTrace's clinical and commercial advisors, Vinayak Smith, on the role of innovative technologies to reduce the risk of litigation in obstetrics!
“Cardiotocography (CTG) has been used for foetal heartrate (FHR) surveillance since the 1970s, as a means of detecting foetal hypoxia and guiding clinical decisions around delivery timing.
Despite the length of its usage, there is yet to be convincing evidence that CTG reduces birth asphyxia, stillbirths, caesareans or instrumental deliveries.
Although the technology is good at providing reassurance when foetal heartrates are ‘normal’, it is less useful at working out the prognosis of ‘abnormal’ heartrates, explains Dr. Vinayak Smith, of Monash University and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
“It is not easy for two clinicians to agree or interpret the same CTG output the same way,” said Dr. Smith ahead of the Obstetric Malpractice Conference.
“Heartrates which look normal are easy to trust, whereas abnormal ones could mean anything. The CTG doesn’t tell us how worried we should be when a heartrate doesn’t look quite right.
“As a result, FHR red flags can be wrongfully dismissed by the clinician, leading to ‘preventable’ delivery complications or, in extreme cases, foetal deaths.
“Conversely, false alarms can lead to unnecessary clinical intervention and greater numbers of (precautionary) C-sections – a procedure which is risky for both mother and baby.”
Aside from the risk of healthcare complications, CTG reliability issues expose clinicians to legal culpability.
With 20 percent of obstetrics claims involving CTG – and obstetrics accounting for a significant proportion of medico legal disputes – it is widely agreed that better foetal monitoring solutions are needed.”