An Overview of Technologies Discussed at this 5th Meeting of ISIS

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John Spencer: "Hello. The two of us here are colleagues who have worked together for a number of years and we meet periodically at conferences, such as the one that's just finished here in Stockholm - the 5th International Study or Symposium for Intrapartum Surveillance. I'm John Spencer, I'm a consultant in London in England working at Northwick Park Hospital, and this is Professor Ingemar Ingemarsson, who works in Lund in Sweden. How did you find this recent meeting Ingemar?"

Ingemar Ingemarsson: "I found it very interesting. We had on the Sunday before the Congress, a training course, which was very well attended with about 80 participants. I think we learned a few new things even if we were both lecturing there."

John Spencer: "I got the feeling that still there are some controversies about what we do, particularly fetal heart rate monitoring interpretation - the use of fetal blood sampling. But it is difficult, isn't it, to present clinical cases out of context and then expect everybody to understand what the pressures were at the time of the management of the case."

Ingemar Ingemarsson: "I think it was a great day for us when we used the EVS - the electronic voting system - because tracings were shown that together with some basic data about women; we saw that there were very divergent opinions about both how the traces should be interpreted and suggestions for management."

John Spencer: "It was a great system to teach with, wasn't it? First of all, to ask the audience what they knew before electrical discussion and see whether there had been any change afterwards."

Ingemar Ingemarsson: "Yes, it really it was a new experience for me. I really enjoyed it."

John Spencer:"There are new things that were presented at this conference. Perhaps I shouldn't say new, but updates on newer technologies. Did you find any particularly promising?"

Ingemar Ingemarsson: "Yes, the scalp blood lactate - lactate strip method - presented by Dr. Westman and Dr. Nordstrom, is now ready for use. Both contributed to the research within that field, and I'm quite confident that we have a new tool, which will be valuable in our clinical management."

John Spencer: "It's a nice method because fetal blood sampling, we both agree, is still a necessity to assist with interpretation of the fetal heart rate during labor. Of course, this just allows the need for only one drop of blood to be obtained from the fetal scalp. You have experience with this, don't you?"

Ingemar Ingemarsson: "Yes, we participated in the multicenter trials and it needs only 5 microliters, which is a fraction of a drip. In fact, Dr. Westman showed that with this method, the successful sampling is much easier achieved compared to scalp blood needing a greater amount of blood."

John Spencer: "I think that our hospital is also contributing to some of the data collections, so we're looking forward to a big trial in the U.K. very shortly. There are other methods that have been around at the previous meetings that haven't quite taken off yet. ECG waveformer, I think, has some potential as a reasonably readily available biological signal. I have some hope that this might progress. Have you had experience with this ECG waveform analysis as well?"

Ingemar Ingemarsson: "Yes, we had to get with two other departments in Sweden, contacting a multicenter study now randomized multicenter study, and we have accredited in all, about 1200 women. We may need 3,600 or 7,200 - we don't really know yet, but we will make the first analyses now in the summer time and have a look at results."

John Spencer: "I think it's always a worry, isn't it, when women hear about us and our researches and our experiments? There's a, hopefully, unfounded fear that women are being experimented on. I presume you participate in ethics committee permission, and inform the women before the studies and reassure them. Do you have any qualms about researching when we're actually trying to manage women?"

Ingemar Ingemarsson: "No, if we have a look at that from a general point of view, I think it's important for the public to know, but we are never doing any scientific study without the permission of the Committee of Ethics - because it's not possible to publish your study today without that approval itself. I think the public should be confident that we are on the right side all the time."

John Spencer: "Of course, we are trying to find the better way of managing when we have some uncertainty at the moment, as to whether we have reached the ultimate best management. Obviously, we have no worry with the management we do with any point in time, but don't think that should stop us from looking to see in a safe way, whether there are better managements for the future. Have you enjoyed this conference?"

Ingemar Ingemarsson: "Yes, very much. I think one thing came up which I would like to take up, and that is our problems with the timing of the fetal brain injury in regard to our surveillance methods. Still we have many problems here, but to think that new methods using MRI and so on, could help us in this and give some new information about this in many times tragic cases. Because I think it's important for the parents to know as good as possible when possible injury to the fetus, to that child, has occurred, I think that is something we can very often."

John Spencer: "Indeed, and sadly we know that most of the handicapped children aren't the result of a problem in labor even though there might still be occasional problems. Yes, that's a very important point. At the moment though, we still remain with the heart rate as the primary tool for watching over the baby during labor, and of course, pregnancy before labor, and using blood samples to check the blood acid during labor or possibly soon in the future blood lactate as an alternative, easier procedure. We hope that the next ISIS meeting and other meetings between us and our colleagues can continue to push forward our understanding and confidence of taking care of women and their children during labor. Thank you, Ingemar, for joining me and this is John Spencer."