New Methods Discussed at ISIS and plans for the next meeting of ISIS to be held in the UK

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Dr. van der Slikke: "Professor Arul, we are here at the ISIS conference in Stockholm, 1999, and we have heard a lot about intrapartum CTG monitoring. Some countries use the fetal scalp sampling and other countries do not, especially the United States - they are afraid of fetal scalp sampling, I understand. But still, the intrapartum CTG can give reasons of doubt and difficulty in reassuring the doctor, and then one of the first steps could be to do a Caesarean section. You did a lot of research in this field. What do you think new methods of preventing Caesarean sections could be, perhaps, but to give a better judgement of the CTG intrapartum?"

Professor Arulkumaran: "Thank you for asking that question. I think it's a very important question that you have raised, and there are a number of issues involved. Number one, as we discussed in the conference, there are a number of babies dying because CTG is not interpreted carefully, and the last confidential inquiry into stillbirths and deaths in infancy reported nearly 70 to 80%. There was some problem in interpretation, or taking appropriate action. The second issue is that there were nearly 240 million pounds paid in compensation in medical litigation last year because of the problems in interpretation of CTG with resulting cerebral palsy and poor neonatal outcome. The third issue, obviously, as you say, is that there is an increase in Caesarean sections because the doctors who are on the grounds are fairly junior, the midwives can be fairly expedient at times, and it can be very difficult to interpret sometimes if the babies are really hypoxic. As a result, we can either do Caesarean sections and increase the C-section rate, or do additional tests like fetal blood sampling. So I think, as you suggested, there have to be other methods we have to look at, and the methods from our late investigation are ST waveform analysis and pulse oximetry. Both are being investigated and will be discussed in this ISIS conference. We had some experience with the fetal pulse oximetry, as with the ECG waveform analysis, and pulse oximetry appears to be one of the methods that might be used in the future. There is a large randomized study that has been completed in the U.S., and we're anxiously awaiting that trial. I'm sure that one or two of these methods will help us to reduce the C-section rate, as well as help the babies to be delivered in good conditions without compromising their fetal conditions."

Dr. van der Slikke: "Thank you. We'll wait for the results from the American trial, which will be available in a few months, I understand."

Professor Arulkumaran: "Yes, that's right."

Dr. van der Slikke: "I understand you're the one who will organize the next ISIS conference in about three years, in Britain?"

Professor Arulkumaran: "Yes, that's right."

Dr. van der Slikke: "Do you already have an idea about the topics that will be addressed there?"

Professor Arulkumaran: "Certainly. I think it will be a good meeting because the American trial is going to be finished, so we will have more information. By the time we have the meeting, in two or three years, there will be other centers which will have done more and more pulse oximetry after being convinced, so we will have those results, too, which will also be discussed. The group that is doing the ECG waveform analysis is doing a large, multi-centre study in Sweden and Norway, and their results will be available, as well. Lactate by micro sampling has been introduced in a big way, and Sweden and Singapore have had some experience. In the U.K., we are starting to use it. So that, again, will give us some good results. We hope by that time we will have not only the immediate clinical outcome in terms of the babies' Apgar scores and pH, but perhaps also one or two follow-up studies based on the outcome using these new methods. I think it will be quite an exciting meeting, and who knows... there might be new methods which are innovative, and we might be able to hear about them then, too."

Dr. van der Slikke: "Thank you very much. It's a lucky baby that will be born in the next millennium."

Professor Arulkumaran: "That's right, thank you."p