A guide to Women's Health on the Internet Part 1: Pregnancy, childbirth and ultrasound

In this column, subject experts have been invited to provide an annotated guide to some of the most useful health sites on the Internet. In this issue Hans van der Slikke, Consultant Obstetrician at Zaandam Hospital, The Netherlands, and Chairman of the International Council of OBGYN.net, provides a guide to some of the best women's health resources now available on the Internet. Part 1 will focus on resources - both general and specific - that will be of interest to professionals working in obstetrics and consumers looking for information on all aspects of childbirth and pregnancy. Part 2. Gynaecology and Reproductive Medicine will look at Internet resources relating to gynaecology, fertility, infertility and gynaecological oncology.

Health professionalsProfessional societies
A first start for professionals could be the site of the International Federation of Obstetrics and Gynaecology(FIGO) (www.figo.org). FIGO is the umbrella for 101 national societies, of which more than 20 have their own websites, including the NVOG, the Obstetrics and Gynaecology Society for the Netherlands (www.nvog.nl/) and the American College of Obstetrics and Gynaecology (www.acog.org/). These sites have a closed, members-only section as well as sections aimed at the general public. In the members area, users can find clinical guidelines and topics devoted to specific areas of specialization. In common with most professional organizations, these pages also include a calendar of meetings with regional information about accreditation of conferences and congresses.

The website of the UK Royal College of Obstetrics and Gynaecology (www.rcog.org.uk/) contains guidelines, rules for medical audit and good clinical practice. In contrast to other society sites, however, this information is visible for everybody - no hiding behind passwords! Crucially, individual recommendations have been graded according to the level of evidence on which they are based using a scheme endorsed by the NHS Executive. Such an approach is highly stimulating for professionals from all over the world who can compare these recommendations with their own guidelines.

Other websites for O&G professionals
The premier gateway to information relating to obstetrics and gynaecology is OBGYN.net (www.obgyn.net/). Referred to as a 'vortal' (vertical portal) OBGYN.net is the world's largest O&G website. The development of this gateway originates from the OB-GYN-L discussion list. The archives of this list are still available, and searchable from 1995, in the Medical Professional Forum (forums.obgyn.net/forums/ob-gyn-l/).

At the OBGYN.net site clinical information has been divided into a number of featured sections. In the field of obstetrics there are: Pregnancy and Childbirth, Foetal Monitoring, and Ultrasound. Each section has its own Editorial/Advisory Board. Recognizing the international nature of the Internet, information in the professional section of the OBGYN.net site is published in four languages: English, Spanish, Portuguese and German.

Although OBGYN.net is a sponsored website with several advertising banners, the editorial content is independent from their sponsors. OBGYN.net's original articles are peer reviewed by the editorial advisers of each section, and the site complies fully to principles devised by the Health on the Net Foundation.

Ultrasound
Within the ultrasound section of OBGYN.net (www.obgyn.net/us/us.htm) obstetricians as well as sonographers can find case studies and an image gallery. Perhaps more originally users can also upload images to the gallery for purposes of consultation and analysis by experts from around the world. The ultrasound section has also started a peer-review system. Under this system only original papers, which have the approval of at least two reviewers, will be published. There is also a very active ultrasound forum for professionals (forums.obgyn.net/ultrasound/). This generates around 100 postings a month and is another excellent way of seeking opinion from colleagues and peers.

From the ultrasound pages there are links to other obstetric ultrasound websites. However, rather than simply providing a hypertext link, all the suggested resources are described, rated (using a simple star system) and arranged in a clear hierarchical format to facilitate navigation. For example, within the section 'Ultrasound Clinical Information Links' resources are divided into categories such as General Resources, Guidelines and Protocols, and Journals.

The Fetus.net site (www.thefetus.net/) developed by Philippe Jeanty is dedicated to obstetric ultrasound. It contains more than 200 articles and around 900 images. One of the best parts is the 'Case of the Week' which takes the form of a clinical puzzle - exciting and instructive in one! Recognizing that some of the material on the site may be disturbing to a nonclinical audience, entrance to this site is only granted once you have accepted a disclaimer page and completed a simple registration form.

The American Institute of Ultrasound site (www.aium.org/) also has a lot of educational material and guidelines in ultrasound. This site is not only of use to obstetricians but also for other specialities who use ultrasound. Regrettably, the most interesting parts of this site are restricted to AIUM members.

The website of the International Society for Ultrasound in O&G (ISUOG) is also worth a visit (obg.med.wayne.edu/ISUOG/home.htm/). ISUOG has become the organization for obstetricians, sonographers and for fetal medicine specialists. The website contains information about forthcoming congresses and events, membership details and, of course, links. One of the links leads to the 'white' journal, namely the Journal of Ultrasound in Obstetrics & Gynaecology (www.parthpub.com/ultra/sound.html/). The contents of each issue are listed, but the full text is not available, even for members or subscribers.

Finally, the Fetal Echocardiography website (www.fetalecho.com/), developed by Greggory R.De Vore, provides information about the foetal echocardiography CD-ROM, and an online ordering form.

Fetal monitoring
Information on the web about fetal monitoring is relatively scarce. One useful starting point is the fetal monitoring section on the OBGYN.net site (www.obgyn.net/fm/fm.htm). This sponsored section has several papers authored by some of the worlds leading experts on CTG and fetal monitoring during labour. This site also includes information on fetal monitoring devices, such as fetal pulse-oximetry.

At the Gestation Net site (www.gest.net) developed for health professionals by Jason Gardosi, fetal growth and surveillance are the main topics. Gardosi, a founder member of ISIS (International Society of Intrapartum Surveillance) is also well known for his CTG-Tutor CD-ROM. For nurses, new on the labour ward and for young residents, the interpretation of CTG's gives a great deal of trouble. With the help of this educational tool, however, one can acquire a good basic knowledge and understanding of this subject. A demonstration version of the CTG-Tutor can be downloaded from this site at: (www.gest.net/ctgtutor.htm).

Midwifery resources
The American College of Nurse-Midwives (www.acnm.org) is the organization of professional midwives in the USA. This site contains a wealth of professional information and educational material. Additional midwife practitioner resources can be found at: www.obgyn.net/pb/links/mp_midwife.htm

The real-life argument between doctors and midwives about the best way to deliver care continues in cyberspace. The Virtual Birth Centre (www.virtualbirth.com) and Carey Ann Ryan's Gentle Birth Midwife (www.gentlebirth.com) are examples of how one-sided the argument can become. Both of these sites, for example, are heavily in favour of home births.

Evidence-based obstetrics
Although obstetrics has a very long history as an empirical science, evidence-based obstetrics helps identify useless (and sometimes even harmful) procedures. A considerable part of the Cochrane Library comprises randomized trials in obstetrics. Indeed, the predecessor of the current Cochrane Library was the Cochrane Childbirth and Pregnancy Database. A selection of relevant abstracts in the current Cochrane Library can be found at: www.update-software.com/ccweb/cochrane/revabstr/g010index.htmConsumers
Most of the websites of the professional organizations (highlighted above) have sections suitable for health consumers. This information will be written in a style and format suitable for a lay audience and, more importantly, be written in the native language of the health consumer. [The patient pages at the Netherlands Society for Obstetrics and Gynaecology (www.nvog.nl) are published in Dutch.]

Pregnancy and childbirth
Consumers looking for medical information concerning pregnancy and birth will find the OBGYN.net section Pregnancy and Birth (www.obgyn.net/pb/pb.htm) a good place to start. One of the most popular corners is the Online Forum (forums.obgyn.net/pregnancy-birth) where women (and men) can ask questions concerning pregnancy problems. Questions are answered by professionals, often very quickly. All postings are archived and these can be searched to identify previous postings and their answers. There are also dedicated chat hours on topics of interest to both pregnant women and new parents. Often, health professionals participate in these live forums.

Of the many commercial sites for pregnant women, Babycenter (www.babycenter.com/rcindex.html) is one of the most extensive. This is a clean and happy looking website with information on all aspects of pregnancy and childbirth. Would-be parents can use the preconception pages to learn about nutrition, prenatal health and even use the online ovulation calculator to determine fertile days. In contrast, parents who are coping with toddler temper tantrums can go to the Toddler pages (www.babycenter.com/toddler/) and read a number of articles on 'toddler discipline'.

Competing for the attention of pregnant women is The Labor of Love website (www.thelaboroflove.com) where a lot of attention is given to interactivity, and the social and emotional side of pregnancy, rather than the medical aspects. In contrast, Childbirth.Org (www.childbirth.org/) adopts a more political approach. The information is presented from a non-clinical view, promoting pregnancy and birth as a natural process. There are fact sheets covering a range of topics such as Caesarean sections (www.childbirth.org/section/CSFAQ.html) and Natural remedies during pregnancy (www.childbirth.org/articles/remedy.html). More classical and well-organized patient education material, where you can 'hear' the voices of US obstetricians, can be found on the ACOG site at: www.acog.org

Sometimes things do not go the way they were expected - a miscarriage occurs or the baby dies. It is a known fact that support groups can become huge virtual communities, who will give comfort and consolation. A good gateway to this world is the Dealing with Grief and Loss website (members.tripod.com/Crystalblue/loss.html). From here there are links to sister organizations such as SIDS (Sudden Infant Death Syndrome) and MEND (Mommies Enduring Neonatal Death).

Utrasound
Joseph Woo's ultrasound website (www.ob-ultrasound.net) has become a real classic. This is a truly comprehensive site, with detailed information written in a way suitable for a lay audience. It gives clear explanation of all kinds of ultrasound procedures and a detailed history of obstetrical ultrasound. There are several links to other websites, where embryos and fetuses in all stages may be viewed.

Conclusion
There is no shortage of information on the Internet relating to pregnancy, childbirth and ultrasound. Indeed, a search of AltaVista for the term 'pregnancy' returns more than 1 million web pages. Recognizing this problem this article has attempted to provide a starting point to some of the best sites on the Web concerned with obstetrics and ultrasound. Part 2 of this article will adopt a similar approach but will focus on chronic conditions such as infertility, endometriosis and oncology.

Hans van der Slikke can be contacted at hans@obgyn.net

References:

Published in: He@lth Information on the Internet, February 2001; Issue 19:p.4-6

He@lth Information on the Internet can be found at

Copyright: Royal Society of Medicine Press