Examples of medical records
The description of the medical records with the answers from the
participants can be found in Table 3 . We also provide a
detailed description of the two medical records for which the rates of
inconsistent answers with regard to the real outcome were the greatest
(Figure 1 ):
Medical Record #7: A 24-year-old woman, gravida 1, para 0, presented at
38 weeks of gestation with oligohydramnios and decreased active foetal
movements in the setting of gestational diabetes with foetal macrosomia
(estimated foetal weight above the 99th percentile). Induction of labour
was achieved with oxytocin under epidural anaesthesia. CTG abnormalities
appeared at 9 cm of cervical dilatation and led to foetal scalp blood
sampling (Figure 1a ). The result was 7.27, and the obstetrician
decided to continue labour with iterative foetal scalp blood sampling.
One hour after the first sampling, the patient vaginally delivered a
3,800 gram newborn boy. The Apgar scores were 10, 10, and 10 at 1, 5 and
10 minutes, respectively, and the umbilical cord pH was 7.17.
Regarding this medical record, 42% of participants would have decided
to perform a caesarean section without using a second-line method (38%
of the participants in the training group and 53% of the participants
in the control group). Only 3 participants (7%) from the training group
would have decided to continue labour without using a second-line
method, and no participant from the control group would have decided to
continue labour.
Medical Record #9: A 38-year-old woman, gravida 1, para 0, presented in
labour at 39 gestational weeks in the setting of gestational diabetes
without foetal macrosomia. CTG abnormalities appeared at 6 cm of
cervical dilatation and led to foetal scalp blood sampling
(Figure 1b ). The result was 7.16, and the obstetrician decided
to perform a caesarean section. The newborn boy weighed 2605 grams and
had Apgar scores of 8, 9, and 9 at 1, 5 and 10 minutes, respectively,
with an umbilical cord pH of 7.14.
He
was admitted to the neonatal intensive care unit for respiratory
distress and required continuous positive airway pressure for 24 hours.
Regarding this medical record, 47% of participants would have decided
to continue labour without using a second-line method (55% of the
participants in the training group and 29% of participants in the
control group). Only two participants (5%) from the training group
would have chosen to perform a caesarean section without using a
second-line method, and one from the control group (6%) would have
chosen to perform a caesarean section.