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"Perinatology
and the Internet"
Pallavi M. Latthe
Birmingham Women’s Health Care NHS Trust, Birmingham, UK (pallavi@latthe.freeserve.co.uk)
Introduction
The Internet has the potential to revolutionise the way we obtain and
disseminate medical information. There is an enormous volume and variety
of health-related information on the Internet [1, 2]. Some information
available on the Internet about perinatology (aimed at professionals) is
discussed here. We restrict ourselves mainly to websites for professionals
in the English language.
Perinatology (general)
A useful place to start reading for perinatology information is at the
World Wide Web links page in the Fetal Monitoring section of OBGYN.net (a
physician-reviewed network for doctors, medical professionals, women and
the medical industry) at http://www.obgyn.net/FM/prof.htm.
This provides a number of links to other sites relevant to perinatology,
such as guidelines and protocols, research, journals and professional
societies. The sites are rated, from one to five stars (though the
criteria used for rating are not explained). It is also possible to find
sites through the OBGYN.net search facility at http://www.obgyn.net/search/search.asp.
There are a number of regional perinatology organisations that have their
own websites. The Society for Maternal-Fetal Medicine, formerly the
Society of Perinatal Obstetricians, has a site at http://www.smfm.org/index.html
which provides a number of resources for research, employment/careers,
meetings and details of the society itself. It also provides access to the
society’s newsletter. The Society for Obstetric Anaesthesia and
Perinatology’s website (http://www.soap.org)
provides a similar range of resources, with a discussion forum as well.
General obstetrics and gynaecology societies
Over 20 national societies under the auspices of FIGO, the International
Federation of Gynecology and Obstetrics (www.figo.org)
have their own websites, including NVOG, the Netherlands Society of
Obstetrics and Gynaecology (www.nvog.nl)
(the first online) and ACOG, the American College of Obstetrics and
Gynecology (www.acog.org). After
entering a password, members have access to clinical guidelines and topics
devoted to specific areas of specialisation. In common with most
professional organisations, the pages also include a calendar of meetings
and conferences. The website of the UK Royal College of Obstetricians and
Gynaecologists (http://www.rcog.org.uk/guidelines/c_guidelines.html)
contains clinical evidence-based guidelines, and standards for medical
audit and good clinical practice. Crucially, individual recommendations
have been graded according to the level of evidence on which they are
based, using a scheme endorsed by the UK National Health Service
Executive. Also, the Canadian society has a rich content of clinical
practice guidelines (http://sogc.medical.org/SOGCnet/
sogc_docs/common/guide/library_e.shtml).
Twin-to-twin transfusion syndrome (TTS)
Although it is difficult to find all the topics in perinatology at one
website, there are several websites available on particular topics of
interest in perinatology. For example, there are a number of interesting
sites about the twin-to-twin transfusion syndrome (TTS). The Twin-to-Twin
Transfusion Syndrome Foundation (http://www.tttsfoundation.org/)
is dedicated to providing educational, emotional and financial support to
families and care-givers before, during and after pregnancies diagnosed
with TTS. The website http://www.fetalmd.com/ttts.htm
provides the details of various treatment options like serial
amniocentesis and laser photocoagulation.
The UK Twin-Twin Transfusion Syndrome Association has a site at http://www.twin2twin.org/
which contains a description of research on birth and babies (including
fetal medicine, obstetrics and neonatology) being carried out at Queen
Charlotte’s Hospital in London (http://www.hammersmithresearch.org/Specialty/birth/birth.htm).
Fetal monitoring
For the midwives and junior doctors who find the interpretation of
cardiotocography (CTG) difficult, the site at http://www.wmpi.net/ctg/index.ctg.htm
provides a CTG tutor to help acquire a good basic knowledge and
understanding of this subject.
More information in general about fetal monitoring (CTG and fetal pulse
oximetry) can be found at www.obgyn.net/fm/fm.asp. A European research project for the evaluation of CTGs is available at http://www.sisporto.med.up.pt
Midwifery resources
The American College of Nurse-Midwives (www.acnm.org)
is an organisation of professional midwives in the USA. This site contains
a wealth of professional information and educational material. Additional
midwife practitioner resources can be found at www.obgyn.net/pb/links/mp_midwife.htm.
The debate between doctors and midwives about the best way to deliver care
continues in cyberspace. The ideal site should give a balanced view of the
risks versus the benefits of home and hospital delivery. But some sites
like The Virtual Birth Centre (www.virtualbirth.com)
and Carey Ann Ryan’s Gentle Birth Midwife (www.gentlebirth.com)
heavily favour home births. This may affect the decision-making of
birthing mothers, and not necessarily for the good.
Evidence-based perinatology
Although obstetrics has a very long history as an empirical science,
evidence-based obstetrics is now the norm. A considerable part of the
Cochrane Library comprises randomised trials in obstetrics. Indeed, the
predecessor of the current Cochrane Library was the Cochrane Childbirth
and Pregnancy Database. Full-text articles from the Cochrane database are available for obstetrics
and gynaecology professionals after registering free of charge at http://www.obgyn.net/cochrane.asp
Journals
A variety of journals are available online, for example, the Journal of
Maternal-Fetal Medicine (http://www.interscience.wiley.com/jpages/1057-0802),
which provides access to past issues, including full-text articles (for
subscribers only), details about the journal, including how to subscribe,
and information for authors wishing to submit articles. Electronic
databases like those of PubMed (http://www.ncbi.nlm.nih.gov/PubMed),
Embase and others provide up-to-date information on evidence related to
all the topics in medicine including perinatology.
UK sites: perinatal audit
There are a number of UK-based sites on perinatology, two of which are
highlighted here.
The West Midlands Perinatal Institute (http://www.wmpi.net)
provides information about the Institute’s activities and information
for those involved in the provision of perinatal care. Information on its
activities regarding the West Midlands Congenital Anomaly Register,
ultrasound and fetal growth is also given.
This website also provides links to other useful sites such as that of the
CESDI (Confidential Enquiry of Stillbirths and Deaths in Infancy). The
CESDI (http://www.cesdi.org.uk)
provides information about its history, organisation and role. Both the
fifth and sixth annual reports are available for downloading, which will
be useful to many healthcare professionals. It also provides postmortem
notes for both professionals and parents, with useful answers to questions
that commonly arise when a postmortem is being considered.
Clinical trials
In a randomised, controlled trial, to allow larger sample sizes, shorter
sampling periods and lower unit costs, new communication methods like the
Internet are useful. The World Wide Web can provide global access, fast
interaction and automation. A prototype Internet Trials Service is
currently being tested with a real international clinical trial: the
Growth Restriction Intervention Trial (http://www.mednet.org.uk/mednet/ca16.htm).
Traditional methods of exchange of research information may not be rapid
enough, especially for international multicentre studies or when
discussing controversial issues such as the value of fetal monitoring. The
Internet is a useful tool that provides numerous opportunities for
immediate communication within a large and diverse community of
researchers. For example, a website at http://www.sisporto.med.up.pt
has been developed for a multicentre research project with interlinked
pages on automated fetal heart rate (FHR) monitoring. It includes
background knowledge about the subject, detailed information about the
project, and a few interactive pages. These pages allow online
discussions, simulations of data analysis, and downloading of data for
local FHR analysis. The Eurofoetus programme (http://www.eurofoetus.org/TTS.htm)
is conducting two main activities in the field of TTS open to
participation of all centres via the Internet: the TTS randomised trial
and the TTS observational study.
How can information be evaluated?
There are many recognised criteria for assessing the quality of websites
in general and for health information in particular [3]. Amongst the most
important criteria for quality are credibility and content [4].
The source of medical information is usually regarded as the main
criterion for its credibility. Currency is shown by websites that display
the date of the original document or content posting on the Internet, and
that of any updates. Hierarchy of evidence posted on each website is a
reliable indicator of the validity of health research. The accuracy of
contents is usually best judged against rigorously developed,
peer-reviewed and published guidelines for each of the topics concerned.
Website quality can also be assessed by features such as disclosure,
links, design, aesthetics, interactivity and ease of use, which are
related more to presentation and usage.
Perinatology on the web: could it be better?
The quality of medical information on the Internet is not accurate
[5–7]. Most of the material available is part of advertisement strategy
and hence could be biased. As for many other areas of medicine, most
perinatology sites are from the USA, and may not always be relevant to the
UK and other European medical communities. Credible organisations should
be able to provide easily accessible information to both patients and
care-givers. There are very few credible sites such as OBGYN.net which
endeavour to do this. Recently, a group of 20 leading health Internet
services have joined to produce a 14-point set of ethical principles
designed to ensure reliable health information and services to as many as
11.5 million consumers [8].
Summary
There are a number of useful sites about perinatology on the World Wide
Web. These can be used for dissemination of information, interaction,
research and support. As with all medical information posted on the
Internet, there is a need for vigilance in evaluating such information
prior to incorporating it in healthcare decision-making.
Acknowledgement
The author would like to thank Dr. M. Latthe for his help with editing the
manuscript.
References
1. Lundberg GD, for the JAMA Review Group. One multimedia-
medical world [editorial]. J Am Med Assoc 1995; 274: 655.
2. Kassirer JP. The next transformation in the delivery of health care
[editorial]. N Engl J Med 1995; 332: 52–4.
3. Kim P, Eng TR, Deering MJ, Maxfield A. Published criteria for
evaluating health related web sites: review. Br Med J 1999; 318: 647–9.
4. Criteria for assessing the quality of health information on the
Internet. URL: http://www.mitretek.org/hiti/showcase/documents/criteria.html
5. Latthe PM, Latthe M, Khan KS. Quality of medical information about
menorrhagia on the worldwide web. Br J Obstet Gynaecol 2000; 107: 39–43.
6. Latthe PM, Latthe M, Khan KS. Quality of information on female
sterilisation available on the Internet. J Obstet Gynaecol 2000; 20:
167–70.
7. Latthe M, Latthe PM, Charlton R. Quality of information on emergency
contraception on the Internet. Br J Fam Plann 2000; 26: 39–43.
8. URL- http://www.ihealthcoalition.org/ethics/ehcode.html
