Methods
A single-center prospective study (CHU Lille, France) was conducted
among obstetrics and gynecology residents from November 2017 to November
2018 whatever their degree of competence (residency lasts 5 years in
France).
The evaluation of the residents
was conducted in 3 stages. The first evaluation session was organized
before our teaching session called ”pre-training period”. After this
first evaluation session, the residents received one hour and half of
teaching on fetal physiology and FHR analysis. The second evaluation
session, called ”post-training period”, was organized after this
teaching and these three sessions were realized at 3 different times
during their internship.
Each assessment session (pre- and post-training period) was organized
into 2 parts: a theoretical part of multiple-choice questions (MCQs),
and a practical part on clinical cases. During the theoretical
evaluation, the residents had to answer a series of 7 multiple-choice
questions. For each question, five answers were proposed and several
answers were possible. They got one point to the question if all the
answers were correct, 0.5 point if they made a mistake and no point
beyond an error. These questions focused on the fetal response to
hypoxemia and thus to fetal physiology during labor.
The practical part was based on 6 clinical cases resulting from real
clinical situations chosen by 2 investigators of the study. These were
cases of singleton pregnancy in labor (spontaneous or induced) at term
and with presence of abnormalities of the FHR for which the medical team
had been solicited. Among the 6 files selected, 5 had been the subject
of one or more FBS for a total of 10 fetal pH measurements actually
achieved. For each of these clinical cases, 3 to 5 periods (27 in total)
were chosen during the labor and at each period the residents had to
analyze the FHR according to the CNGOF classification (10) divided into
5 categories: normal, low risk of acidosis, intermediate risk of
acidosis, significant risk of acidosis, major risk. They were then asked
if they achieved FBS or not, and the estimate of the result of this pH
measurement : below 7.20, between 7.20 and 7.25 or above 7.25 (3). The
second evaluation session (after teaching) was based on the same
clinical cases, the neonatal outcome was not given at the end of the
first session so as not to influence the answers (11).
The teaching session consisted of a 1.5 hour course. During this session
the basics of fetal physiology and FHR analysis were recalled. This
class was based on the literature on this topic (12,13) and carried out
in a team working in experimental development of a new fetal monitoring
tool based on the analysis of the autonomic nervous system (14,15).