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International Journal of
Gynaecology and Obstetrics Research
ARCHIVES
VOL. 6, ISSUE 1 (2024)
Evaluation of ‘Advanced Intermittent Auscultation (AIA)’, ‘Intelligent Intermittent Auscultation’ and ‘NICE guidelines’ proves AIA as most scientific and safe, avoiding serious risks from the latter two regimes.
Authors
Shashikant L Sholapurkar
Abstract

Intermittent Auscultation (IA) of fetal heart rate (FHR) is widely practiced across the world and its scientific validity is important for perinatal safety. United Kingdom has led in the field of ‘IA’ and the guidelines by National Institute for Health and Care Excellence (NICE) are emulated world over. The NICE, the so-called ‘Intelligent Intermittent Auscultation (IIA)’ and ‘Physiological IA’ guidelines insist that the fetal heart sounds must be actually counted for one minute after contraction even when using a hand-held Doppler device (ignoring the digital display) and documented as a single number. On the other hand, a practical regime of ‘Advanced Intermittent Auscultation (AIA)’ disbands the (mistaken) ideological commitment to actually counting the fetal heart sounds and thereby amplifying the ability of midwives to detect the all-important temporal variations in FHR while using Doppler monitors. This article re-analyses an investigation disseminated by “NHS Resolution” in 2020 following many cases of severe birth asphyxia, which categorically assigned full accountability on the midwives for not following the NICE guidelines. The highest level of evidence of mathematical facts in real clinical cases proves that it was the unsafe methodology of NICE and IIA which was primarily and largely responsible for these severe fetal hypoxemic encephalopathies. The midwife was forced into serious errors because of the methodology by NICE and similar regimes. The article shows how even today the babies remain systemically exposed to serious harm and midwives to unfair blame and distress due to unscientific NICE, IIA and similar guidelines. When pointed out that a count over one minute gives a random average figure, not representative of anything when there has been an acceleration or deceleration; the IIA recommended an obsolete multiple-count method (adopted by K2MSTM) which was practiced in 1980s before Doppler devices were available. This method is inaccurate / suboptimal, very difficult in first stage and almost impossible to practice in the second stage.

This article compares the common IA regimes and shows that the AIA is the most scientific, practical, pragmatic and safe regime. The serious patient safety concerns of NICE / IIA regimes and the scientific superiority of AIA have been raised with the regulatory bodies. The K2MSTM responded that they are guided by the ‘popular’ demand from midwifery interest-groups. In that sense the training online package like K2MSTM does not lead the education but follow demand by interest-groups. This contrasts with the trust by majority midwives that they are being guided and mandated by scientifically credible and safe guidelines. This article empowers midwives to critically analyse the scientific validity and practicality of the different modules by NICE, IIA and AIA, to protect their patients and themselves from harm. With that they should individually and in groups convey their opinions and concerns to the authorities like Royal College of Midwives (RCM) and K2MSTM. The forward-looking AIA will enable the British midwifery practice to maintain its leadership in the field of IA and achieve future progress rather than remaining stuck in the previous century.
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Pages:1-9
How to cite this article:
Shashikant L Sholapurkar "Evaluation of ‘Advanced Intermittent Auscultation (AIA)’, ‘Intelligent Intermittent Auscultation’ and ‘NICE guidelines’ proves AIA as most scientific and safe, avoiding serious risks from the latter two regimes.". International Journal of Gynaecology and Obstetrics Research, Vol 6, Issue 1, 2024, Pages 1-9
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