Perinatology and the Internet

Introduction
The Internet has the potential to revolutionise the way we obtain and disseminate medical information. There is an enormous volume and variety of health-related information on the Internet [1, 2]. Some information available on the Internet about perinatology (aimed at professionals) is discussed here. We restrict ourselves mainly to websites for professionals in the English language.

Perinatology (general)
A useful place to start reading for perinatology information is at the World Wide Web links page in the Fetal Monitoring section of OBGYN.net (a physician-reviewed network for doctors, medical professionals, women and the medical industry) at http://www.obgyn.net/FM/prof.htm. This provides a number of links to other sites relevant to perinatology, such as guidelines and protocols, research, journals and professional societies. The sites are rated, from one to five stars (though the criteria used for rating are not explained). It is also possible to find sites through the OBGYN.net search facility at http://www.obgyn.net/search/search.asp.

There are a number of regional perinatology organisations that have their own websites. The Society for Maternal-Fetal Medicine, formerly the Society of Perinatal Obstetricians, has a site at http://www.smfm.org/index.html which provides a number of resources for research, employment/careers, meetings and details of the society itself. It also provides access to the society’s newsletter. The Society for Obstetric Anaesthesia and Perinatology’s website (http://www.soap.org) provides a similar range of resources, with a discussion forum as well.

General obstetrics and gynaecology societies
Over 20 national societies under the auspices of FIGO, the International Federation of Gynecology and Obstetrics (www.figo.org) have their own websites, including NVOG, the Netherlands Society of Obstetrics and Gynaecology (www.nvog.nl) (the first online) and ACOG, the American College of Obstetrics and Gynecology (www.acog.org). After entering a password, members have access to clinical guidelines and topics devoted to specific areas of specialisation. In common with most professional organisations, the pages also include a calendar of meetings and conferences. The website of the UK Royal College of Obstetricians and Gynaecologists (http://www.rcog.org.uk/guidelines/c_guidelines.html) contains clinical evidence-based guidelines, and standards for medical audit and good clinical practice. Crucially, individual recommendations have been graded according to the level of evidence on which they are based, using a scheme endorsed by the UK National Health Service Executive. Also, the Canadian society has a rich content of clinical practice guidelines (http://sogc.medical.org/SOGCnet/ sogc_docs/common/guide/library_e.shtml).

Twin-to-twin transfusion syndrome (TTS)
Although it is difficult to find all the topics in perinatology at one website, there are several websites available on particular topics of interest in perinatology. For example, there are a number of interesting sites about the twin-to-twin transfusion syndrome (TTS). The Twin-to-Twin Transfusion Syndrome Foundation (http://www.tttsfoundation.org/) is dedicated to providing educational, emotional and financial support to families and care-givers before, during and after pregnancies diagnosed with TTS. The website http://www.fetalmd.com/ttts.htm provides the details of various treatment options like serial amniocentesis and laser photocoagulation.

The UK Twin-Twin Transfusion Syndrome Association has a site at http://www.twin2twin.org/ which contains a description of research on birth and babies (including fetal medicine, obstetrics and neonatology) being carried out at Queen Charlotte’s Hospital in London (http://www.hammersmithresearch.org/Specialty/birth/birth.htm).

Fetal monitoring
For the midwives and junior doctors who find the interpretation of cardiotocography (CTG) difficult, the site at http://www.wmpi.net/ctg/index.ctg.htm provides a CTG tutor to help acquire a good basic knowledge and understanding of this subject. More information in general about fetal monitoring (CTG and fetal pulse oximetry) can be found at www.obgyn.net/fm/fm.asp. A European research project for the evaluation of CTGs is available at http://www.sisporto.med.up.pt 

Midwifery resources
The American College of Nurse-Midwives (www.acnm.org) is an organisation 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 debate between doctors and midwives about the best way to deliver care continues in cyberspace. The ideal site should give a balanced view of the risks versus the benefits of home and hospital delivery. But some sites like The Virtual Birth Centre (www.virtualbirth.com) and Carey Ann Ryan’s Gentle Birth Midwife (www.gentlebirth.com) heavily favour home births. This may affect the decision-making of birthing mothers, and not necessarily for the good.

Evidence-based perinatology
Although obstetrics has a very long history as an empirical science, evidence-based obstetrics is now the norm. A considerable part of the Cochrane Library comprises randomised trials in obstetrics. Indeed, the predecessor of the current Cochrane Library was the Cochrane Childbirth and Pregnancy Database.  Full-text articles from the Cochrane database are available for obstetrics and gynaecology professionals after registering free of charge at http://www.obgyn.net/cochrane.asp 

Journals
A variety of journals are available online, for example, the Journal of Maternal-Fetal Medicine (http://www.interscience.wiley.com/jpages/1057-0802), which provides access to past issues, including full-text articles (for subscribers only), details about the journal, including how to subscribe, and information for authors wishing to submit articles. Electronic databases like those of PubMed (http://www.ncbi.nlm.nih.gov/PubMed), Embase and others provide up-to-date information on evidence related to all the topics in medicine including perinatology.

UK sites: perinatal audit
There are a number of UK-based sites on perinatology, two of which are highlighted here. The West Midlands Perinatal Institute (http://www.wmpi.net) provides information about the Institute’s activities and information for those involved in the provision of perinatal care. Information on its activities regarding the West Midlands Congenital Anomaly Register, ultrasound and fetal growth is also given. This website also provides links to other useful sites such as that of the CESDI (Confidential Enquiry of Stillbirths and Deaths in Infancy). The CESDI (http://www.cesdi.org.uk) provides information about its history, organisation and role. Both the fifth and sixth annual reports are available for downloading, which will be useful to many healthcare professionals. It also provides postmortem notes for both professionals and parents, with useful answers to questions that commonly arise when a postmortem is being considered.

Clinical trials
In a randomised, controlled trial, to allow larger sample sizes, shorter sampling periods and lower unit costs, new communication methods like the Internet are useful. The World Wide Web can provide global access, fast interaction and automation. A prototype Internet Trials Service is currently being tested with a real international clinical trial: the Growth Restriction Intervention Trial (http://www.mednet.org.uk/mednet/ca16.htm). Traditional methods of exchange of research information may not be rapid enough, especially for international multicentre studies or when discussing controversial issues such as the value of fetal monitoring. The Internet is a useful tool that provides numerous opportunities for immediate communication within a large and diverse community of researchers. For example, a website at http://www.sisporto.med.up.pt has been developed for a multicentre research project with interlinked pages on automated fetal heart rate (FHR) monitoring. It includes background knowledge about the subject, detailed information about the project, and a few interactive pages. These pages allow online discussions, simulations of data analysis, and downloading of data for local FHR analysis. The Eurofoetus programme (http://www.eurofoetus.org/TTS.htm) is conducting two main activities in the field of TTS open to participation of all centres via the Internet: the TTS randomised trial and the TTS observational study.

How can information be evaluated?
There are many recognised criteria for assessing the quality of websites in general and for health information in particular [3]. Amongst the most important criteria for quality are credibility and content [4]. The source of medical information is usually regarded as the main criterion for its credibility. Currency is shown by websites that display the date of the original document or content posting on the Internet, and that of any updates. Hierarchy of evidence posted on each website is a reliable indicator of the validity of health research. The accuracy of contents is usually best judged against rigorously developed, peer-reviewed and published guidelines for each of the topics concerned. Website quality can also be assessed by features such as disclosure, links, design, aesthetics, interactivity and ease of use, which are related more to presentation and usage.

Perinatology on the web: could it be better?
The quality of medical information on the Internet is not accurate [5–7]. Most of the material available is part of advertisement strategy and hence could be biased. As for many other areas of medicine, most perinatology sites are from the USA, and may not always be relevant to the UK and other European medical communities. Credible organisations should be able to provide easily accessible information to both patients and care-givers. There are very few credible sites such as OBGYN.net which endeavour to do this. Recently, a group of 20 leading health Internet services have joined to produce a 14-point set of ethical principles designed to ensure reliable health information and services to as many as 11.5 million consumers [8].

Summary
There are a number of useful sites about perinatology on the World Wide Web. These can be used for dissemination of information, interaction, research and support. As with all medical information posted on the Internet, there is a need for vigilance in evaluating such information prior to incorporating it in healthcare decision-making.

Acknowledgement
The author would like to thank Dr. M. Latthe for his help with editing the manuscript.

References:

References

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6. Latthe PM, Latthe M, Khan KS. Quality of information on female sterilisation available on the Internet. J Obstet Gynaecol 2000; 20: 167–70.

7. Latthe M, Latthe PM, Charlton R. Quality of information on emergency contraception on the Internet. Br J Fam Plann 2000; 26: 39–43.

8. URL- http://www.ihealthcoalition.org/ethics/ehcode.html