Kazuo Maeda

: This is Roberta Speyer reporting from the World Congress in 		  Perinatal Medicine 2009 in Berlin, Germany. I am here with Professor Maeda and 		  we are going to discuss the changes over time since the 1960's to current times 	    in the evolution of fetal monitoring.

Professor, you began your work back in the 1960's, what was fetal monitoring 		  like at that time?

: Yes, at that time, before you started to record 		  the fetal heart rate and uterine contractions at the same time as always by machine, 		  so by the fetal heart sound, so there's a fetal heart sound dopra signals, but 		  that's a tremor, a fetal heart sound, in the _______ technique. Sometimes internal 		  mess up of the fetal electrocardiogram was common. But it doesn't monitor the 		  patient during pregnancy, only during the delivery.

: Okay, only during the delivery. This was when you had the band 		  around the stomach and it would require one machine and one person running the 		  machine and the patient. And it was only recording the baby. It wasn't something 		  that could be used during pregnancy or monitoring the mother. Correct?

: During pregnancy also there was everybody. At 		  that time an expert was needed, so that would be an obstetrical physician or 		  a nurse or a midwife, they should very clearly know how to diagnose the CTC record.

: So they need to look at it and interpret it.

: Continuously, so if the labor goes on for ten hours or 12 hours 		  you need another expert to come in and take over.

: It is very difficult to do work by person in 		  very many deliveries.

: So now we are going to fast forward, turn of the century, new 		  technology, and new ways of using technology. What is the setting now? Before 		  you had one person who had to be an expert, watching one person who is pregnant 		  or in labor, and if you wanted to have ten people, you had to have ten machines 		  and ten experts. Now what is it like?

: If there are thousand deliveries in a year they 		  should appoint 30 deliveries at the same time, so 30 machines and 30 experts 		  in a day and night are necessary.

: It's very expensive and probably not even easy to do, to find 		  that many experts all the time.

: Almost impossible. So that role would be done 		  by a central computer.

: With a centralized computing system how many people are you 		  now able to monitor with one expert?

: One expert - so experts' role will be done by 		  the computer. It has a program to download the CTC. The machines divides the 		  signals of 30 people into 30 channels of the computer.

: Now you have 30 people able to monitor and the role is not required 		  for the person doing the monitoring to be at quite a high level of expertise 		  because the computer is doing the interpretation. What does it do, set off an 		  alarm or something if there is a problem? If certain levels go, and then you 		  can bring in the expert.

: That's a problem should be very correct. We 		  did it from the 1970's until now. There will be an expert's analysis system, 		  also a newer network computer, and the fetal heart rate frequency analysis - 		  the three combined and very correct diagnosis __________.

: Your outcomes with this type of data, have you been able to 		  reduce any of the typical problems in labor? What have been your outcomes?

: There are results of the diagnosis would be 		  conducted to attending doctors. The method is also very important. My idea is 		  to use the cell phone.

: Everyone does! So the attending doctor keeps 		  a cell phone; their own cell phone. Then either initiation of the monitoring 		  phone number is registered in the computer, then if any very difficult things 		  appear it should be conducted to the cell phone. It is a very direct way to inform.

: Sometimes it is necessary for some intervention 		  in delivery, including forceps, _______, sometimes a cesarean section.

: Cesarean section. Decisions like that can be made. This probably 		  reduces the incidence of things like cerebral palsy.

: I think so because in our experience, in a small 		  number of deliveries, there is perinatal mortality of the fetus on the ________ 		  was reduced, especially reduced, and also cerebral palsy reduced to one third. 		  In a hospital it becomes almost zero.

: Even the very good effects have zero ________ 		  rate not so much increased, because that is much to the diagnosis. In Japan the 		  average cesarean section rate now will be 12 to 15 percent.

: Twelve to 15 percent average C-section rate in Japan, which 		  is much higher in the United States and many other countries. If you are able 		  to monitor correctly with the system then you are able to tell that you do not 		  need to do a c-section, that maybe what you would have observed and thought required 		  one, does not really require one. Is that why it is helping?

: Yes. These days obstetric physician has already 		  been reduced and because of some special programs, they need some more simplified 		  monitoring technique. Time needs to be saved for the obstetrician.

: We have the same problem in the United States. Less people coming 		  out of, for example, maternal fetal medicine residency programs than are retiring 		  every year. So there are less and less doctors handling more and more deliveries.

It's fascinating. What do you predict in the next 50 years. What do you think 		  when you look ahead and wonder where it is all going to go.

: Next is expanding this technique of CTC monitoring 		  into the undeveloped countries.

: So you could take the CTC monitoring there?

: Present CTC monitoring is a very expert ability, 		  to diagnose the CTC. It needs very long study. For example, obstetric doctors. 		  But in the developing countries, there is a small facility for medicine. But 		  also there is very uneducated deliveries.

: No experts almost in some places, or one expert for thousands 		  and thousands of people. They might just be one doctor, not necessarily a perinatologist 		  or an obstetrician, correct?

Because I imagine the size of the equipment and the capabilities are getting 		  smaller and smaller, do you see these being able to be easily portable like a 		  laptop computer or something?

: It’s just like that now. Also the patients, 		  perinatal agreement is not necessary to be connected to the machine by wire.

: Telemetry system, the signals for fetal heart 		  rate or the uterine contraction is transmitted to the computer by radio wave.

: Really. Is it going by satellite, or...?

: The perinatal woman can move, can eat, can get 		  up and go to the toilet.

: She can get up and move around. That's good when you are in 		  labor. I had five children, you need to move around.

: Do you predict in the future, in the third world countries, 		  that we will be able to get the data from very remote areas and maybe have a 		  perinatologist that is in Europe or in Japan and is able to give advice to people 		  in Africa, sub-Sahara and southeast Asia? That's where it is going eventually?

: Perhaps, all perinatal will be monitored in 		  the future, in the old world.

: This would be the true answer to the problem and the dilemma 		  of the mother and the fetal death rate in these countries, is the technology 		  to be able to bring that level of care and understanding. You cannot bring all 		  those people down there but if you can bring the machines there.

: I am a medical doctor but always interested 		  in the computer and some medical _________ so I always __________ expanding our 		  knowledge to all people.

: Well, I think that the world certainly owes you a great deal 		  of credit for what you have done. We all know that you are world famous for your 		  work. You changed fetal monitoring and the face of medicine and so many lives. 		  I look forward to seeing the future and how this technology can be applied to 		  third world countries to improve care for women and their babies all over the 		  world.

Articles

Coverage of the 2009 World Congress of Perinatal Medicine

Kazuo Maeda

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