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

2. 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.

3. 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.

4. Humans vs machine?

5. Humans vs machine? Machines in obstetrics = ultrasound

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

7. 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

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

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

10. 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

11. 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

12. 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 ?

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

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

15. Why worry ?

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

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

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

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

21. And for fetal head position ?

22. Nizard et al. Am J Obstet Gynecol 2009.

23. And station is probably the same

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

25. Can ultrasound replace cervical dilatation assessment ?

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

27. Is it important to assess fetal progression with precision ?

28. 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...

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

31. 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

32. 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