COMPARISON OF. TRANSVAGINAL DIGITAL EXAMINATION WITH SPATIAL POSITION-TRACKING ... doi:10.1016/j.ajog.2008.09.237. 211 DETERMINING ...
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HOW RELIABLE IS DETERMINATION OF CERVICAL DILATATION? COMPARISON OF TRANSVAGINAL DIGITAL EXAMINATION WITH SPATIAL POSITION-TRACKING RULER JACKY NIZARD1, SHOSHANA HABERMAN2, YOAV PALTIELI3, RON GONEN4, GONEN OHEL5, DIANE NICHOLSON2, YVES VILLE1, 1CHI Poissy-St-Germain-en-Laye, Poissy, France, 2Maimonides Medical Center, Brooklyn, New York, 3Bnai Zion Medical Center, Trig Medical Ltd, Haifa, Israel, 4Bnai Zion Medical Center, Technion, Haifa, Israel, 5Bnai Zion Medical Center, Technion, Haifa, Haifa, Israel OBJECTIVE: To compare digital assessment of cervical dilatation with simultaneous measurements of the distance between two opposing cervical margins using a finger mounted position sensor. STUDY DESIGN: This prospective study conducted in Poissy, France; Brooklyn, USA; and Haifa, Israel, included 333 measurements performed in 188 women with term, singleton vertex pregnancies, during the active stage of normal labor. Ninety measurements with clinical diagnosis of full dilatation were excluded from analysis. Measurements were performed using the LaborPro system, by attaching a small position snesor to the midwife=s index fingertip. Evaluations were done when cervical examinations were clinically indicated. Differences were calculated as LaborPro result – trans-vaginal result, with LaborPro as a reference. Center poolability was assessed via a t-test. RESULTS: Results were similar in all centers. Mean error was 10.2⫾8.4 mm, ranging from 7.5⫾7.3 mm when cervical dilatation was above 8 cm, to 12.5⫾8.7 mm when cervical dilatation was between 6.1 and 8 cm. Proportion of subjects with an accuracy ⬍ 10mm shows the same patterns – the proportions of accurate results are similar for the 0 to 4.0 cm (68.3%), 4.1 to 6.0 cm (52.1%) and ⬎8 cm (70.0%) sections, and significantly lower (p⫽0.0014) for the 6.1 to 8.0 cm section (38.8%). CONCLUSION: This in situ evaluation of cervical assessment during vaginal examination shows that clinical evaluation has limited precision. Clinical assessment accuracy was worst between 6.1 and 8 cm of dilatation.
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0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.237
NEONATAL ORGAN SYSTEM INJURY IS UNRELATED TO THE SEVERITY OF ACUTE BIRTH ASPHYXIA JEFFREY PHELAN1, LISA KORST2, GILBERT MARTIN3, 1Citrus Valley Medical Center OB/Gyn, City of Industry, California, 2USC Keck School of Medicine, OB/GYN, Los Angeles, California, 3Citrus Valley Medical Center, Neonatology, West Covina, California OBJECTIVE: To examine the prevalence of major organ dysfunction among neonates with and without catastrophic intrapartum asphyxia. STUDY DESIGN: Fetuses with a sudden, rapid and sustained deterioration that lasted until delivery from a previously reactive FHR pattern were identified in a registry of singleton term brain-damaged neonates. Catastrophic intrapartum asphyxia was defined as a uterine rupture with a partial or complete expulsion of the fetus and/or the placenta. Neonatal organ dysfunction was contrasted between those fetuses with catastrophic asphyxia (Group 1), and those without catastrophic asphyxia but with and without a clinically recognizable sentinel hypoxic event such as abruption or shoulder dystocia (Groups 2 and 3, respectively). Neonatal organ injury was defined as follows and did not include CNS injury: Renal-serum creatinine ⱖ1.0 mg/dl or oliguria (⬍1.0 cc/kg/hr); Hepatic-Elevation of SGOT or SGPT ⬎100 U/L or LDH ⬎100 U/L or LDH 600 U/L; Cardiac-pressors for support or CPK ⬎400 U/L or abnormal echocardiogram; Pulmonary- ventilator support; Gastrointestinal- gasless abdomen on x-ray; and Hematologic- first NRBC ⱖ12%, NRBC Clearance time ⱖ80 hours, first platelet count ⬍150,000 /mm3or a platelet count ⬍100,000 /mm3within 5 days of birth. RESULTS: Of 111 eligible cases, 44 (40%) were classified in Group 1, 39 (35%) in Group 2, and 28 (25%) in Group 3. The prevalence of organ dysfunction for each Group respectively was: Hepatic 32% vs. 15% vs. 32% (P ⫽ 0.1657); Renal 91% vs. 92% vs. 96% (P ⫽ 0.6701); Gastrointestinal 16% vs. 18% vs. 11% (0.7127); Pulmonary 80% vs. 72% vs. 86% (P ⫽ 0.3825); Cardiac 46% vs. 36% vs. 43% (P ⫽ 0.6673); and Hematologic 55% vs. 74% vs. 78% (P ⫽ 0.1566). CONCLUSION: Among infants with permanent neonatal brain injury, catastrophic intrapartum asphyxia did not appear to be associated with an increase in neonatal organ dysfunction. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.239
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DETERMINING THE VALUE OF FORCE-FEEDBACK SIMULATION TRAINING FOR SHOULDER DYSTOCIA JENNIFER KELLY1, JEANNE-MARIE GUISE2, PATRICIA OSTERWEIL3, HONG LI4, 1Oregon Health & Science University, Obstetrics and Gynecology, Portland, Oregon, 2Oregon Health and Science University, Maternal Fetal Medicine, Portland, Oregon, 3Oregon Health and Science University, Portland, Oregon, 4Oregon Health & Science University, Portland, Oregon OBJECTIVE: To discover if force feedback simulation training is useful to clinicians in determining the maximum threshold of force to use during shoulder dystocia deliveries. STUDY DESIGN: Obstetricians, family physicians and certified nurse midwives that deliver at OHSU were invited to participate in a study to determine the educational value of obstetric simulation. The PROMPT™ birthing simulator was used to simulate shoulder dystocia deliveries and to provide force-feedback training. Participants underwent a shoulder dystocia delivery simulation, teaching session, and then a post-teaching delivery simulation. Applied delivery forces were measured for each delivery before and after training. The maximum force (in Newtons), number and percentage peak forces that were ⬎100N were compared using the paired t-test. RESULTS: A total of 40 providers (28 OB, 6 Family Medicine, 6 CNMs) participated in force simulation training. Participants ranged from first year interns to 34 years post training. Maximum peak forces, number of peaks ⬎100N and percentage of peaks ⬎100N were all significantly reduced after training (P⬍0.0001 for all). Training was equally effective regardless of gender, training, or delivery experience. CONCLUSION: Forces applied during simulated shoulder dystocia deliveries were significantly reduced following force feedback training. Force-feedback is a potentially useful method for providers to self-train maximum force threshold in shoulder dystocia deliveries.
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0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.238
CAN WE PREDICT UNCOMPLICATED DELIVERY? A PROSPECTIVE OBSERVATIONAL STUDY JASMIN OZ1, ORLY SARID2, RONY PELEG3, EYAL SHEINER1, 1Soroka University Medical Center, Ben-Gurion Universiy of he Negev, Department of Obstetrics and Gynecology, Beer Sheva, Israel, 2Ben-Gurion Universiy of he Negev, Beer Sheva, Israel, 3Ben Gurion University of the Negev, Family Medicine, Faculty of Healh Sciences, Beer-Sheva, -, Israel OBJECTIVE: The present study aimed to investigate factors predicting uncomplicated deliveries, and specifically whether a sense of coherence (SOC) and perceived stress can predict such deliveries. STUDY DESIGN: A prospective observational study was conducted employing self-administered SOC and Perceived Stress Scale (PSS) questionnaires with pregnant women attending the outpatient clinic for routine surveillance. Following delivery, data regarding maternal and fetal delivery complications were collected from the participants’ medical records. RESULTS: Of one-hundred and forty five women completing the study, 41.4% completed the delivery process without complications. Women experiencing delivery complications, on average, had lower SOC scores (68⫾1.17 vs. 72⫾1.36, p ⫽ 0.03). Maternal complications (as opposed to fetal complications) accounted for this divergence and were related to lower SOC scores (67.74⫾1.19 vs. 72.18⫾1.32, p ⫽ 0.01). PSS was not associated with uncomplicated delivery (18.20⫾0.64 vs. 18.63⫾0.58, p ⫽ 0.626). Nulliparity however, was associated with higher occurrence of complicated delivery (31.9% of complicated vs. 13.2% of uncomplicated deliveries, p ⫽ 0.01). Multivariable analysis demonstrated that SOC (OR⫽1.042; 95% CI⫽1.004-1.08; p ⫽ 0.03) and nulliparity (OR⫽0.293; 95% CI⫽ 0.113-0.758; p ⫽ 0.011) were both independent predictors of uncomplicated delivery, directly and inversely, respectively. CONCLUSION: Higher SOC scores are an independent protective factor for the prediction of uncomplicated delivery. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.240
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American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2008
