Human factors in obstetrics: Labour J. Nizard Paris, France

Good morning, I am Sabine Macron, obstetrician at the hospital la pitie salpetriere in Paris and i present you a monocentric retrospective french study about the managment of pregnancy in women with mechanical heart valve.

Disclosure The author report no financial conflict of interest. Research with: General Electric Trig Medical Philips Good morning, I am Sabine Macron, obstetrician at the hospital la pitie salpetriere in Paris and i present you a monocentric retrospective french study about the managment of pregnancy in women with mechanical heart valve.

Humans vs machine?

Humans vs machine? Machines in obstetrics = ultrasound

Ultrasound in labour: Placenta position Uterine scar Cord Vasa praevia Twins position Station/position

Where do we need more reliability/accuracy in labour monitoring? CTG analysis Determining when labour starts Assessing labour is progressing normally Progression = several evaluation in time Parameters evaluated

What do we evaluate to determine labour progression? Fetal position (head) Fetal head station Cervical dilatation

What do we evaluate to determine labour progression? Fetal position (head) Fetal head station Cervical dilatation And then lines = partogram

What do we evaluate to determine labour progression? Fetal position (head) Fetal head station Cervical dilatation And then lines = partogram Defining what is a normal partogram

What are the risks of not having reliable measurements? False positive : you say it progresses where it doesn’t False negative : you say it doesn’t progress where it does

What are the risks of not having reliable measurements? False positive : you say it progresses where it doesn’t = Danger for the baby ? False negative : you say it doesn’t progress where it does = Excessive cesarean section ?

What are the risks of not having reliable measurements? Good assessment = healthier babies ? = less cesarean sections ?

Labor Monitoring: Based on vaginal examination Differs from one country to another From every hour  on demand Risks? Infections Error

Why worry ?

Cervical simulators, 1-10cm, Consultants, miwives, fellows, trainees 53% accuracy, 89% if +/-1cm 52% intra-operator variability, …11% if +/-1cm

Cervical simulators, 1-6cm, short/long, herd/soft Consultants, midwives, trainees 54%/19% accuracy Trainees less accurate

In labouring patients Professors vs consultats, fellows 49% concordance Difference of 2 cm or more in 11%

Cervical dilatation: Nizard et al. Am J Obstet Gynecol 2009.

And for fetal head position ?

Nizard et al. Am J Obstet Gynecol 2009.

And station is probably the same

« Angle of progression » Barbera et al. Ultrasound Obstet Gynecol 2009.

Can ultrasound replace cervical dilatation assessment ?

Station vs dilatation Haberman et al. Ultrasound Obstet Gynecol 2011.

Is it important to assess fetal progression with precision ?

Is it important to assess fetal progression with precision Is it important to assess fetal progression with precision ? It depends of your definition of non progressive labour...

Recent research taught us:. (if mother and fetus wellbeing) Recent research taught us: (if mother and fetus wellbeing) - Do not examine too frequently

Recent research taught us:. (if mother and fetus wellbeing) Recent research taught us: (if mother and fetus wellbeing) - Do not examine too frequently - Be very patient

Recent research taught us:. (if mother and fetus wellbeing) Recent research taught us: (if mother and fetus wellbeing) - Do not examine too frequently - Be very patient - When in need of reliable information, some tools are more better than clinical assessment