Introduction

Perinatal asphyxia, a condition that results from compromised placental or pulmonary gas exchange during the birth process, is rare but can lead to serious neonatal and long-term consequences. The visual analysis of cardiotocography (CTG) is designed to avoid perinatal asphyxia, but its interpretation can be difficult. Our aim was to test the impact of an e-learning training program for interpreting CTG on the rate of avoidable perinatal asphyxia at term.

Method

We conducted a retrospective multicenter before-after study comparing two periods, before and after the implementation of e-learning training program from July 1, 2016 to December 31, 2016, in CTG interpretation for midwives and obstetricians in five maternity hospitals in the Paris area, France. The training involved theoretical aspects such as fetal physiology and heart rhythm abnormalities, followed by practical exercises using real case studies to enhance skills in interpreting CTG. We included all term births that occurred between the “before” period (July 1 to December 31, 2014) and the “after period (January 1 to June 30, 2017). We excluded multiple pregnancies, antenatal detection of congenital abnormalities, breech births and all scheduled caesarean sections. Perinatal asphyxia cases were analyzed by a pair of experts consisting of midwives and obstetricians, and avoidability of perinatal asphyxia was estimated. The main criterion was the prevalence of avoidable perinatal asphyxia.

Results

The e-learning program was performed by 83% of the obstetrician-gynecologists and 65% of the midwives working in the delivery rooms of the five centers. The prevalence of perinatal asphyxia was 0.45% (29/7902 births) before the training and 0.54% (35/7722) after. The rate of perinatal asphyxia rated as avoidable was 0.30% of live births before the training and 0.28% after (p = 0.870). The main causes of perinatal asphyxia deemed avoidable were delay in reactions to severe CTG anomalies and errors in the analysis and interpretation of the CTG. These causes did not differ between the two periods.

Conclusion

One session of e-learning training to analyze CTG was not associated with a reduction in avoidable perinatal asphyxia. Other types of e-learning, repeated and implemented over a longer period should be evaluated.

中文翻译：

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电子学习培训对解释产时胎心率监测以避免围产期窒息的影响：一项前后多中心观察性研究

介绍

围产期窒息是一种因分娩过程中胎盘或肺部气体交换受损而导致的疾病，这种情况很少见，但可能会导致严重的新生儿和长期后果。宫缩监护 (CTG) 的视觉分析旨在避免围产期窒息，但其解释可能很困难。我们的目的是测试解释 CTG 的电子学习培训计划对可避免的围产期足月窒息率的影响。

方法

我们对巴黎地区五家妇产医院的助产士和产科医生进行了一项回顾性多中心前后研究，比较了2016年7月1日至2016年12月31日实施电子学习培训计划前后的两个时期的CTG解读， 法国。培训涉及胎儿生理学和心律异常等理论方面，随后通过真实案例研究进行实践练习，以提高解释 CTG 的技能。我们纳入了“之前”期间（2014年7月1日至12月31日）和“之后”期间（2017年1月1日至6月30日）之间发生的所有足月出生。我们排除了多胎妊娠、先天性异常的产前检测、臀位分娩和所有预定的剖腹产手术。由助产士和产科医生组成的一对专家对围产期窒息病例进行了分析，并估计了围产期窒息的可避免性。主要标准是可避免的围产期窒息的发生率。

结果

五个中心产房中 83% 的妇产科医生和 65% 的助产士参与了在线学习计划。培训前围生期窒息发生率为0.45%（29/7902），培训后为0.54%（35/7722）。训练前活产婴儿中可避免的围产期窒息率为 0.30%，训练后为 0.28%（p = 0.870）。被认为可以避免的围产期窒息的主要原因是对严重 CTG 异常的反应延迟以及 CTG 分析和解释中的错误。这些原因在两个时期之间没有差异。

结论

一次分析 CTG 的电子学习培训与可避免的围产期窒息的减少无关。应评估长期重复和实施的其他类型的电子学习。