1 Monitoraggio Strumentale del Travaglio di Parto Sergio CASCIARO, PhD, Eng CONSIGLIO NAZIONALE DELLE RICERCHE I.F.C. Dip. di Ingegneria Biomedica, Scienze e Tecnologie Mediche Lecce, Italy Lodi, 15 maggio 2010
2 Programma della presentazione Introduzione Gestione del parto Necessità Strumentale Strumentazione Disponibile per la cervicometria Dispositivo in fase di sviluppo Conclusioni
4 Intro - Medical Decision Taking In Italy, the average national rate of caesarean sections is equal to 38%, against an ideal 15% recommended by the World Health Organization. Moreover, those values are much higher than the average European rate (23,7%). New methods and technologies for standardised quantitative monitoring and appropriate medical decision taking.
5 Intro - Labor Monitoring Nowadays in most Obs Dpts MANUAL DIGITAL CHECKS represent the only way of monitoring cervix dilatation (1 Pmt!) A systematic and CONTINUOUS MONITORING would provide great benefit in order to early diagnose pathologic labor (distocia and other COMPLICATIONS) Furthermore, real time monitoring and parameter recording would reduce LEGAL LITIGATIONS and related costs
6 Labor Monitoring - Partogram PARTOGRAM (Friedman 1954!!) consists of measuring 2 parameters: Cervix Dilatation and Head Station.
7 Labor Monitoring - SOLUTIONS Possible Practical SOLUTIONS for Labor Monitoring Improvements: 1. Echographic Monitoring performed by Experts (short term and long term!!!) 2. New Technologies and Methods for non-invasive and accurate Automatic Quantitative Monitoring
8 SISTEMI COMMERCIALI
9 Labor Monitoring Devices: State of the Art BirthTrack System (Barnev Inc., Andover, MA, USA; Barnev Ltd., Netanya, Israel) LaborPro System (Trig Medical Inc., Ridgefield, NJ, USA; Trig Medical Ltd., Yoqneam Ilit, Israel) SonoVCADlabor (GE Healthcare 9900 Innovation Drive Wauwatosa, WI U.S.A.)
10 Labor Monitoring Devices: State of the Art Last years two products commercially appeared which enable cervix dilation and head station measurement (2 Pmts), not commonly employed due to strong Limitations (Post membrane rupture, cable sensors inserted in vagina) BirthTrack System (Barnev Inc., Andover, MA, USA; Barnev Ltd., Netanya, Israel) LaborPro System (Trig Medical Inc., Ridgefield, NJ, USA; Trig Medical Ltd., Yoqneam Ilit, Israel)
11 Labor Monitoring Devices: State of the Art Last year a software SonoVCADlabor for quantification of Labor parameters through 3D translabial sonography SonoVCADlabor (GE Healthcare 9900 Innovation Drive Wauwatosa, WI U.S.A.) (Ghi et al. 2009)
12 NUOVO SISTEMA IN FASE DI SVILUPPO
13 BREVETTI CNR: MONDO Ultrasonic apparatus for measuring a labor progress parameter APPLICATION N : PCT/EP2009/ ITALY Apparato basato sugli ultrasuoni per misurare parametri indicatori di avanzamento di un parto APPLICATION N : PI 2008 A118
14 Ultrasound Labor Monitoring Main New Features of patented systems: Quantitative external non invasive automatic measurement of main indicators of labor progress during all stages (1, 2 and 3 stages)!
15 Ultrasound Labor Monitoring MAIN INDICATORS OF INTEREST WE CAN NOW MEASURE DURING LABOR: Contractions (frequency, duration, etc) Head Station Head and Shoulder Position Cervical Dilatation Others (Heartbeating of Fetus, ) Monitoring in Real Time Referring to anatomical sites and personalized to the specific case Recording of Parameters for research and to reduce potential legal litigations Automatic Correlation and Warning through Neural Networks for medical decision support ( Caesarean Section) Intuitive User Interaction low learning time.
16 New System for Labor Monitoring: Introduction
17 New System for Labor Monitoring: Main Features
18 New System for Labor Monitoring: Main Features Accuracy of the employed algorithm (Errors are expressed as bias ± 2SD, according to the Bland-Altman statistics).
19 Conclusion Ultrasound Labor Monitoring After our preliminary tests quantitative external non invasive automatic measurement of main indicators of labor progress during all stages result to be feasible in a robust and reliable manner. Labor complications would be earlier diagnosed and properly managed reducing risks for both mothers and newborns. By recording the all parameters of interest legal litigation would be reduced and the learning of doctors improved. Given the available algorithms and available related expertise time to market could be extremely reduced. This system would bring great benefit to pregnancy management, reduce costs and facilitate doctors supporting them in their decisions and operations by mean of quantitative automatic approach.
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