L’enregistrement du rythme cardiaque fœtal et la gestion des événements indésirables graves : pourquoi et comment élaborer un programme de formation des cliniciens ?

Fetal physiology cardiotocography training, a regional evaluation

INTRODUCTION

Cardiotocography (CTG) has its limits in detecting fetal acidosis and intrapartum asphyxia. Our aim was to evaluate a CTG training programme based on fetal physiology in the Mediterranean perinatal network.

METHODS

Professionals from 41 maternity units of the Mediterranean network were invited to participate in a CTG masterclass based on fetal physiology in March 2019 and October 2019. They were asked to react to three practical cases by a physiological approach before the training course (T0), one month after (T1) and six to seven months after (T2). The mean scores were compared by using a mixed model including lapse of time to evaluation, profession of participants and level of the maternity unit as fixed effects.

RESULTS

A total of 248 professionals from 32 maternity units finally participated in the organizational audit. By using a mixed model, we found a significant improvement of the mean score at T1=6.44/10 compared to T0=4.97/10 (p<0.0001), and a significant improvement of the mean score obtained at T2=6.17/10 compared to T0 (p<0.0001). T2 scores were not significantly different from T1 scores (p=0.143).

DISCUSSION

A CTG training programme based on fetal physiology showed a significant improvement in the professionals' interpretation of CTG at short term and stable results at long term. Continuing medical education could help maintain and improve knowledge to ensure neonatal safety.

[Fetal heart rate analysis: Evaluation of an in situ training program on cardiotocography interpretation during labor in the Auvergne-Rhône-Alpes region (France)]

OBJECTIVES

To evaluate an in situ training program on caradiotocography interpretation during labor in the Auvergne-Rhône-Alpes region (France).

METHODS

Fifteen hospital maternity unit took part to an "outreach visit" training on fetal cardiotocography interpretation between November 2011 and 2015. Professionals were asked to answer to a 10 questions test based on the French classification of fetal heart rate, at inclusion (Test 0: T0), immediately after (Test 1: T1), and long time after the training (Test 2: T2). The mean score for each maternity (T0, T1, T2) was compared individually. Subgroup analysis considered the level of perinatal care of each maternity (level 1 or 2) and the type of practice (public or private).

RESULTS

The study included 332 healthcare professionals belonging to 8 level 1 (53.5%) and 7 level 2 (47.7%) maternity units. The T0 mean score was 4.79 (IC 95% [4.54; 5.02]) instead of 6.71(IC 95% [6.49; 6.93]) at T1 (P<0.05). Seventeen professionals (22.9%) answered T2 with a mean time of 35.2 months (Median value: 40 months) and a mean score of 5.32. The mean score was significantly higher at T2 than at T0 (5.32-IC 95%[4.94-5.70] (P<0.001) but lower than the score at T1 (P<0.05).

CONCLUSION

An "outreach visit" training on fetal cardiotocography interpretation improves theknowledge of healthcare professionals at short and long term.