Making Birthing Safer with Airstrip OB

Introduction by Ed Zabrek, M.D., F.A.C.O.G., Medical Editor of Smartphone & Pocket PC magazine

I have worked with the incredible team from MP4 Solutions, LP, developers of AirStrip OB, for over a year, and have written several articles about this product in this magazine. In addition, I have actively campaigned for a system-wide deployment at Memorial Herman Healthcare Systems in Houston, Texas, the corporation that runs my hospital. As a result, we will be starting a beta test on the product in January 2007. If successful (and I have no doubt it will be), Memorial Hermann will support the deployment of AirStrip OB for all the Obstetricians in their hospitals.

In September 2006 a very complete, well written analysis and review of AirStrip OB by Joseph SanFilippo, MD, MBA, appeared in OBGYN Management. With the kind permission from the publishers, we herein reprint that article which was created with the support of an educational grant from GE Healthcare.)

The challenge

Failure to accurately interpret and communicate electronic fetal monitoring (EFM) patterns threatens fetal wellbeing and results in costly litigation. Electronic fetal monitoring is used in 85% of the 4 million live births in the United States annually to detect changes in the heart rate indicative of hypoxia. This approach to monitoring became the standard of care after longterm studies indicated that intrapartum fetal deaths decreased as use of EFM increased. However, the ability of an obstetrician to act on signs of fetal distress depends on close monitoring and quick communication about potential problems.

The reality of obstetrical care necessitates the periodic absence of the obstetrician from labor and delivery (L&D). In some circumstances understaffed hospitals, nurses with minimal training in EFM, and terminology differences between nurses and physicians can create an environment for increased liability risk for the obstetrician and the hospital.

AirStrip OB, an FDA-approved software system, is a valuable technology that allows obstetricians to coordinate decision-making in real-time from a distance, eliminating potentially inadequate verbal descriptions of visual charts and tracings. Using a hand-held Pocket PC or Smartphone, obstetricians can remotely access virtual real-time, high-resolution fetal heart rate (FHR) tracings, maternal contraction patterns, and other critical data from L&D units.

AirStrip OB works on Pocket PC Phone Edition devices like the Sprint PPC6700

Interfacing with the hospital's GE Centricity Perinatal (formerly QS) centralized monitoring system over a cell phone network or wireless Internet, AirStrip OB provides access to patient history and exam records including cervical exam, membrane status, vital signs, and nurse notations. (See Medical Information Sidebar)

With the ability to transform communication about a patient in labor, AirStrip OB technology allows obstetricians and members of the L&D team to coordinate care and provide optimum patient outcomes. Reacting to concerns from the L&D team, obstetricians can respond as problems arise, reducing the impact of complications and lowering the risk of adverse events associated with delivery. Most important, clinicians gain the ability to proactively review tracings and ensure that their patients are receiving the care that the specific situation requires.

Fetal hypoxia: The importance of immediate intervention

The primary purpose of EFM is early identification of fetal hypoxia to prevent intrapartum fetal asphyxia. Relative to weight, fetal oxygen consumption is twice that of an adult, and the fetus' oxygen reserve will only meet its metabolic needs for 1 to 2 minutes.

Without adequate oxygen supply, the fetus will quickly develop hypoxia. Subsequent anaerobic metabolism leads to production of lactic and pyruvic acids and the development of acidosis. Alterations of the fetal heart tracing reflect fetal distress due to the loss of biochemical homeostasis.