Cardiotocography interpretation skills and the association with size of maternity unit, years of obstetric work experience and healthcare professional background: a national cross-sectional study

Thellesen, Line; Sørensen, Jette Led; Hedegaard, Morten; Rosthoej, Susanne; Colov, Nina Palmgren; Andersen, Kristine Sylvan; Bergholt, Thomas

doi:10.1111/aogs.13171

Cited by 12 publications

(11 citation statements)

References 26 publications

(26 reference statements)

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“…The number of births per year defines the size of a maternity unit. Maternity units are defined as small when <1000 births per year occur, medium‐sized when between 1000 and 1999 births occur, and large when units have >2000 births per year 30,31 . Large maternity units are responsible for a greater number of high‐risk pregnancies.…”

Section: Discussionmentioning

confidence: 99%

How common is substandard obstetric care in adverse events of birth asphyxia, shoulder dystocia and postpartum hemorrhage? Findings from an external inspection of Norwegian maternity units

Johansen

Braut

Acharya

et al. 2020

Acta Obstet Gynecol Scand

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Introduction The Norwegian Board of Health Supervision inspects healthcare institutions to ensure safety and quality of health and welfare services. A planned inspection of 12 maternity units aimed to investigate the practice of obstetric care in the case of birth asphyxia, shoulder dystocia and severe postpartum hemorrhage. Material and methods The inspection was carried out at two large, four medium and six small maternity units in Norway in 2016 to investigate adverse events that occurred between 1 January and 31 December 2014. Six of them were selected as control units. The Norwegian Board of Health Supervision searched the Medical Birth Registry of Norway to identify adverse events in each of the categories and then requested access to the medical records for all patients identified. Information about guidelines, formal teaching and simulation training at each unit was obtained by sending a questionnaire to the obstetrician in charge of each maternity unit. Results The obstetric units inspected had 553 serious adverse events of birth asphyxia, shoulder dystocia or severe postpartum hemorrhage among 17 323 deliveries. Twenty‐nine events were excluded from further analysis due to erroneous coding or missing data in the patients’ medical records. We included 524 cases (3.0% of all deliveries) of adverse events in the final analysis. Medical errors caused by substandard care were present in 295 (56.2%) cases. There was no difference in the prevalence of substandard care among the maternity units according to their size. Surprisingly, we found significantly fewer cases with substandard care in the units which the supervisory authorities considered particularly risky before the inspection, compared with the control units. Seven of the 12 units had regular formal teaching and training arrangements for obstetric healthcare personnel as outlined in the national guidelines. Conclusions Prevalence of adverse events was 3% and similar in all maternity units irrespective of their size. A breach in the standard of care was observed in 56.2% of cases and almost half of the maternity units did not follow national recommendations regarding teaching and practical training of obstetric personnel, suggesting that they should focus on implementing guidelines and training their staff.

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Section: Discussionmentioning

confidence: 99%

How common is substandard obstetric care in adverse events of birth asphyxia, shoulder dystocia and postpartum hemorrhage? Findings from an external inspection of Norwegian maternity units

Johansen

Braut

Acharya

et al. 2020

Acta Obstet Gynecol Scand

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“…It is therefore recommended to evaluate an education intervention on different levels . In a separate study, we found the CTG education program to have a positive effect on the two lower levels (reaction and learning) in Kirkpatrick's evaluation model …”

Section: Discussionmentioning

confidence: 83%

“…37,38 In a separate study, we found the CTG education program to have a positive effect on the two lower levels (reaction and learning) in Kirkpatrick's evaluation model. 22,39 Prospectively, it seems relevant to integrate other evaluation approaches with more focus on process and context to answer how and why an education intervention did or did not have an effect. 40,41…”

Section: Discussionmentioning

confidence: 99%

“…Completion of the e‐learning program was a prerequisite for attending the 1‐day course. The e‐learning and the 1‐day course are described in previous publications …”

Section: Methodsmentioning

confidence: 99%

“…The e-learning and the 1-day course are described in previous publications. 18,21,22 Briefly, the e-learning program took approximately 4 hours to complete and could be taken at or outside of the hospital. Datasets were delivered with encrypted personal identification numbers, thus all data processing was conducted anonymously.…”

Section: Key Messagementioning

confidence: 99%

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The impact of a national cardiotocography education program on neonatal and maternal outcomes: A historical cohort study

Thellesen

Bergholt

Sørensen

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Studies indicate an association between errors in cardiotocography (CTG) management and hypoxic brain injuries among newborns. Continuing professional education is recommended. We aimed to examine whether the implementation of a national interprofessional CTG education program in Denmark was associated with a decrease in risk of fetal hypoxia measured by umbilical cord pH < 7.00, 5‐minute Apgar score <7 or neonatal therapeutic hypothermia. As a secondary aim, we assessed whether the educational intervention was associated with an increase in operative deliveries. Material and methods We conducted a historical cohort study from 2009 to 2015 including all intended vaginal deliveries with liveborn singletons in cephalic presentation and gestational age ≥37 weeks. Data were retrieved from the Medical Birth Register and the National Patient Register. The study period was divided in three: pre‐implementation (2009‐2012), implementation (2013) and post‐implementation (2014‐2015). Using logistic regression we estimated odds ratios (OR) of fetal hypoxia outcomes using the pre‐implementation period as reference. Analyses were adjusted for potential maternal, neonatal and delivery‐associated confounders. Missing data were accounted for by multiple imputation. Results In all, 331 282 deliveries were included. Overall risks of pH < 7.00, Apgar score <7 and therapeutic hypothermia were respectively 0.45%, 0.58% and 0.06%. Adjusted OR in the post‐implementation period were 1.12 (95% confidence interval [CI] 1.00‐1.26), 0.99 (95% CI 0.90‐1.10) and 1.34 (95% CI 0.99‐1.82) for the three outcomes, respectively. The pH missingness equaled 12.4%. Odds of emergency cesarean section was unaltered, whereas the odds of assisted vaginal delivery decreased by 14% (0.86, 95% CI 0.84‐0.89). Conclusions Healthcare professionals are considered the weakest link of CTG technology. We did not find that increasing healthcare professionals’ CTG interpretation skills affected the risk of fetal hypoxia. Missing data for pH values were substantial and represent a limitation of the study. We cannot with certainty rule out that missingness masked a true effect of the intervention. Our study indicates that assisted vaginal deliveries can be decreased without an increased risk of fetal hypoxia. Dilution of effect in a complex clinical setting, rare outcomes, insufficient intervention and a possible overestimation of the impact of errors in CTG management might explain the lack of effect.

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Digital cardiotocography: What is the optimal sampling frequency?

Romagnoli

Sbrollini

Burattini

et al. 2019

Biomedical Signal Processing and Control

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Cardiotocography interpretation skills and the association with size of maternity unit, years of obstetric work experience and healthcare professional background: a national cross-sectional study

Cited by 12 publications

References 26 publications

How common is substandard obstetric care in adverse events of birth asphyxia, shoulder dystocia and postpartum hemorrhage? Findings from an external inspection of Norwegian maternity units

How common is substandard obstetric care in adverse events of birth asphyxia, shoulder dystocia and postpartum hemorrhage? Findings from an external inspection of Norwegian maternity units

The impact of a national cardiotocography education program on neonatal and maternal outcomes: A historical cohort study

Digital cardiotocography: What is the optimal sampling frequency?

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