Evaluation and impact of fetal physiology training on fetal heart rate
analysis.
Abstract
Objective - This study aims to assess fetal physiology training in terms
of theoretical knowledge, fetal heart rate interpretation and use of
second-line examination. Design - - Single-center prospective study (CHU
Lille, France) Setting - The evaluation of fetal well-being during labor
is based on fetal heart rate (FHR) analysis and requires knowledge of
physiology. Population - Obstetrics and gynecology residents from
November 2017 to November 2018 (n=34) Methods – The training was
conducted in 3 steps: a session of FHR interpretation and the use of
fetal scalp blood sampling (FBS) on clinical cases, then a teaching
session on fetal physiology, and finally another session on the same
cases presented in the first one. Main Outcome Measures – Theoretical
knowledge evaluation (MCQs), number of FBS requested, the
reproducibility of responses. Results - Almost 3% estimated their
training sufficient on fetal physiology, 11.8% on fetal heart rate
analysis and 14.7% on second-line examination. The training allowed a
significant improvement of their theoretical knowledge evaluation
(mediane [IQR] : 1.5[1.0 to 2.0] vs 4.0[3.0 to 4.5] of MCQs,
p <0.001)), a decrease in the number of FBS requested (36.3%
vs 29.5%, p =0.002). The Krippendorff’s alpha index assessing the
reproducibility of their response was significantly improved, reflecting
a better homogenization of practices (alpha [IC95] : 0.60[0.55 to
0.65] vs 0.72[0.67 to 0.76]). Conclusions - The improvement of
knowledge in fetal physiology allows a better interpretation of the FHR
with better indications of second-line examinations and a homogenization
of practices. Funding- None