Work in Intrapartum Surveillance

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Dr. Gardosi: "I'm Jason Gardosi, the co-organizer of ISIS 5 in Stockholm, and I'm sitting here with two of our invited speakers - Professor Arulkumaran, from Derby and Nottingham University and Professor Mike Rogers, from Hong Kong. First of all, I would like to ask them their impressions of the meeting so far, and then to give us some idea about the work that they themselves are involved in in the field of intrapartum surveillance. Aru, you have now been here not only today, but also yesterday where you were a great help with the participation of our first master class in CTG monitoring. That of course, only represents your past experience which is tremendous in the area of teaching of the interpretation of the CTG. Do you feel this is an important aspect of a meeting like this?"

Professor Arulkumaran: "Thank you Jason. First of all, I think it's one of the highlights of the meeting. I think the master class provided information, which the participants really needed. I think it is time that we organize more master classes like this. Based on the feedback of many of the participants, they learned a lot and although we do similar classes in the United Kingdom and in other places, this was an opportunity where you could get the best teachers from around the world. I think that it was one of the best sessions - appreciated by even the teachers."

Dr. Gardosi: "Thank you. I think we all appreciate it. Mike Rogers, if I may come to you - your impressions about the first day?"

Professor Rogers: "I think it's been a very productive day, certainly the first sessions, which I was involved in, were very argumentative. Everybody from the audience gave us lots of participation. I think we had some very productive discussions, and generally, I've been very pleased with it."

Dr. Gardosi: "May I ask that you, perhaps, elaborate on your special area of interest as far as intrapartum monitoring is concerned? I know you have a whole range of projects."

Professor Rogers: "My main interest is in interventional obstetrics; in order to assess the value of intervention in obstetrics, I've felt for many years that we've had inadequate outcome measures mainly because serious mobility and mortality is very rare now a days. We've been left with measures such as Apgar score and pH base excess, which I felt personally has been inadequate as a means of assessing what we're doing as obstetricians. As you know, we've been exploring other methods of assessing the baby, in particular - lipid for oxidation. This is a footprint of oxygen radical activity of possible fetal distress. We believe that we've come across a mechanism which we can use, certainly in research - not necessarily in practical obstetrics, but certainly in the research and intervention, which is a much more precise and comparable."

Dr. Gardosi: "Thank you. Aru, you're busy in a whole number of different directions including FIGO, where you're treasurer and have a lot of other international commitments. Today you gave us an overview of the confidential inquiries into stillbirths and deaths in infancy. Would you like to summarize what are the take home messages, and what are the lessons that we can learn from these reviews that have been going on in the U.K. over the last few years?"

Professor Arulkumaran: "Thank you Jason. The issue, which I raised, was mainly to do with the messages that came from the confidential inquiry - especially the fourth report, which dealt with the intrapartum deaths. It was very clear from that, that in about 70-80% of cases, the medical doctors and the midwives associated with the cases could have acted differently in order to bring a different outcome. We are talking about the mortality here, and when we talk about numbers - it was about 873 cases. When we talk about mortality, there is certainly some degree of mobility involved, which we didn't discuss today but we discussed yesterday, and the medical difference union has paid out 260 million pounds last year in the U.K. So there's a considerable importance that we had to pay for how we interpret fetal heart tracings, how we are going to act, and how we can reduce this burden of mortality and mobility. So the key message was that, although we are expected to practice evidence based medicine, we don't have sufficient evidence to reject continuous fetal heart rate monitoring, as certainly in the higher situations and in the lower situations we have to adopt some selection process so that we will reduce the mortality and mobility."

Dr. Gardosi: "Thank you very much gentlemen. You heard two perspectives, which in a way also sum up the two issues that run in parallel in this meeting. On the one hand, the examination of what we have today and what we're using as technology and our methods and strategies to monitor the baby; also at the same time, the new research to try to look at better outcome measures and new technologies to take it further. This to me is what ISIS is about and has been over the last ten years. I'm very pleased that we once again have what is generally been regarded as a successful meeting. I hope that with the continuation of these discussions, we will perhaps, make a difference and improve monitoring of babies during labor."