Selection of medical records
Ten medical records of term pregnant women who delivered in our unit between 2019 and 2020 and presented CTG abnormalities for whom a second-line method was used were carefully selected among forty records. Four reviewers were involved in this selection process and had access to the entire record (before and after foetal scalp blood sampling, including the neonatal status). The four reviewers were experienced obstetricians, including one expert in the court.
They were given the same instructions:
For patients for whom a caesarean section was performed, the record could be retained only if the foetal scalp blood sampling (pH) was less than 7.20 and if the reviewers deemed that caesarean section was the only reasonable decision to preserve foetal well-being. The record could not be retained if one or more reviewers deemed that another reasonable solution existed to avoid or delay a caesarean section (e.g., begin expulsive efforts, modify oxytocin administration). According to these criteria, four records of patients for whom a caesarean section was performed after foetal scalp blood sampling were retained and presented to the participants.
For patients who had a vaginal delivery, the record could be retained only if the foetal scalp blood sampling (pH) was greater than 7.20, if the delivery occurred at least one hour after the foetal scalp blood sampling and if the reviewers deemed that continuing the labour had been a reasonable decision based on the neonatal status. According to these criteria, six records were selected.
The four reviewers had to agree that a medical record met the required criteria for it to be selected. In any case of disagreement among the reviewers, the medical record was not retained for presentation. Their judgement was based on the entire medical record, including the neonatal status after delivery.