Acceptability of the fetal electrocardiographic (STAN®) monitoring system by staff at a high-risk maternity unit

Abstract

Sir, We read with great interest the article by Parisaei et al. w1x in which they presented the acceptability of the new fetal monitoring system STAN to a high-risk labor ward. We performed a similar, but a region-wide, questionnaire after the introduction of STAN in Flanders, Belgium. In October 2008, we send a questionnaire to 110 midwives and gynecologists who had 1–3 years previously received training in STAN fetal monitoring in our center. The response rate was 57% (ns63), the respondents were 12 (19%) gynecologists and 51 (81%) midwives. We asked whether they had the impression that after the introduction of STAN the number of artificial deliveries, both vaginally and by cesarean section, for fetal distress had decreased (ns36; 57%), increased (ns5; 8%), did not change (ns7; 11%) or they did not know (ns15; 24%). We also evaluated whether they found the method easy to learn and easy to use in practice (ns28; 44%), easy to use but difficult to learn (understand the theory, ns23; 36%), difficult to learn both in theory and to use in practice (ns2.3%) or easy to learn in theory but difficult to use in practice (ns10; 16%). The number of deliveries in which STAN was used in the respondents’ practices ranged from 10% to 80% (median 30%). When asked whether they felt that from a medicolegal point of view, STAN vs. CTG alone was experienced as safer (ns21; 33%), no difference (ns16; 25%), less safe (ns20; 32%) or do not know (ns6; 10%). We presented a theoretical case in which we asked if in a term primigravid nulliparous women in labor in the second stage of labor and with an abnormal cardiotocogram demonstrating complicated variable decelerations, they would wait for 60 min, unless further fetal deterioration, if no ST-events occurred, as advised by STAN guidelines; or intervene immediately based solely on the cardiotocogram. Of the respondents 44 (70%) would follow the STAN guidelines and wait. But 17 (27%) would intervene immediately, and 2 (3%) did not know. We did not offer the possibility of fetal scalp pH measurement as it was not available in these centers. This means that even in this purely theoretical situation, a high percentage of users would not follow the guidelines, which might be even higher in a real-life situation. For us this underscores the importance of training, retraining and continuous evaluation. We believe these data support and enlarge the conclusion drawn by Parisaei et al. w1x, namely that the introduction of this new monitoring system, not only to high-risk labor wards, but also to general labor wards, is possible but that easy to understand theoretical support and easy to reach practical solutions is necessary. Otherwise, the benefits of this new method might get lost. Both authors have give courses in STAN monitoring organized by Neoventa.