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.