Jason Gardosi, MD

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 "I'm       Jason Gardosi, the co-organizer of ISIS 5 in Stockholm, and I'm sitting       here with two of our invited speakers - Professor Arulkumaran, from Derby       and Nottingham University and Professor Mike Rogers, from Hong Kong. First       of all, I would like to ask them their impressions of the meeting so far,       and then to give us some idea about the work that they themselves are       involved in in the field of intrapartum surveillance. Aru, you have now       been here not only today, but also yesterday where you were a great help       with the participation of our first master class in CTG monitoring. That       of course, only represents your past experience which is tremendous in the       area of teaching of the interpretation of the CTG. Do you feel this is an       important aspect of a meeting like this?"
       
       

"Thank       you Jason. First of all, I think it's one of the highlights of the       meeting. I think the master class provided information, which the       participants really needed. I think it is time that we organize more       master classes like this. Based on the feedback of many of the       participants, they learned a lot and although we do similar classes in the       United Kingdom and in other places, this was an opportunity where you       could get the best teachers from around the world. I think that it was one       of the best sessions - appreciated by even the teachers."
       
       

 "Thank       you. I think we all appreciate it. Mike Rogers, if I may come to you -       your impressions about the first day?"
       
       

 "I       think it's been a very productive day, certainly the first sessions, which       I was involved in, were very argumentative. Everybody from the audience       gave us lots of participation. I think we had some very productive       discussions, and generally, I've been very pleased with it."
       
       

 "May I       ask that you, perhaps, elaborate on your special area of interest as far       as intrapartum monitoring is concerned? I know you have a whole range of       projects."
       
       

 "My       main interest is in interventional obstetrics; in order to assess the       value of intervention in obstetrics, I've felt for many years that we've       had inadequate outcome measures mainly because serious mobility and       mortality is very rare now a days. We've been left with measures such as       Apgar score and pH base excess, which I felt personally has been       inadequate as a means of assessing what we're doing as obstetricians. As       you know, we've been exploring other methods of assessing the baby, in       particular - lipid for oxidation. This is a footprint of oxygen radical       activity of possible fetal distress. We believe that we've come across a       mechanism which we can use, certainly in research - not necessarily in       practical obstetrics, but certainly in the research and intervention,       which is a much more precise and comparable."
       
       

 "Thank       you. Aru, you're busy in a whole number of different directions including       FIGO, where you're treasurer and have a lot of other international       commitments. Today you gave us an overview of the confidential inquiries       into stillbirths and deaths in infancy. Would you like to summarize what       are the take home messages, and what are the lessons that we can learn       from these reviews that have been going on in the U.K. over the last few       years?"
       
       

"Thank       you Jason. The issue, which I raised, was mainly to do with the messages       that came from the confidential inquiry - especially the fourth report,       which dealt with the intrapartum deaths. It was very clear from that, that       in about 70-80% of cases, the medical doctors and the midwives associated       with the cases could have acted differently in order to bring a different       outcome. We are talking about the mortality here, and when we talk about       numbers - it was about 873 cases. When we talk about mortality, there is       certainly some degree of mobility involved, which we didn't discuss today       but we discussed yesterday, and the medical difference union has paid out       260 million pounds last year in the U.K. So there's a considerable       importance that we had to pay for how we interpret fetal heart tracings,       how we are going to act, and how we can reduce this burden of mortality       and mobility. So the key message was that, although we are expected to       practice evidence based medicine, we don't have sufficient evidence to       reject continuous fetal heart rate monitoring, as certainly in the higher       situations and in the lower situations we have to adopt some selection       process so that we will reduce the mortality and mobility."
       
       

 "Thank       you very much gentlemen. You heard two perspectives, which in a way also       sum up the two issues that run in parallel in this meeting. On the one       hand, the examination of what we have today and what we're using as       technology and our methods and strategies to monitor the baby; also at the       same time, the new research to try to look at better outcome measures and       new technologies to take it further. This to me is what ISIS is about and       has been over the last ten years. I'm very pleased that we once again have       what is generally been regarded as a successful meeting. I hope that with       the continuation of these discussions, we will perhaps, make a difference       and improve monitoring of babies during labor."

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OBGYN.net Conference Coveragefrom: International Symposium on Intrapartum Surveillance (ISIS)5th Meeting - Stockholm, Sweden - June, 1999

Jason Gardosi, MD

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Work in Intrapartum Surveillance