Evolving Practices in field of Obstetrics. Techniques that are out of date. Episdoe #138

While many things have remained the same for millenia, the field of Obstetrics and Gynecology (OB-GYN) has witnessed remarkable advancements over the years, revolutionizing the way healthcare professionals care for pregnant individuals and women's reproductive health. As medical understanding deepens and technology progresses, certain practices that were once considered standard have fallen out of favor. In this epidsode, we will explore techniques that were once commonly used the field of obstetircs but are no longer the go-to methods due to advancements in medical knowledge and technology.  Some of the examples on this podcast include fetal scalp sampling, L/S ratios, Quad testing, and Wet preps. 

1. Fetal Scalp Sampling

Fetal scalp sampling, also known as fetal scalp blood sampling (FBS), was a procedure frequently employed to assess the well-being of a fetus during labor. The procedure involved sampling a small amount of blood from the fetal scalp to monitor oxygen levels and acidity (pH) during contractions. It was particularly useful in cases of uncertain fetal well-being. However, the procedure had its limitations, including the potential for infection and fetal injury.

Advancements in electronic fetal monitoring and non-invasive techniques like fetal heart rate monitoring have largely replaced the need for fetal scalp sampling. These modern methods provide real-time information about the fetal heart rate, oxygen levels, and other important parameters, making them safer and more effective alternatives.

2. LS Ratios

Lecithin-sphingomyelin (LS) ratio testing was a method used to predict fetal lung maturity. The ratio between these two phospholipids in amniotic fluid was believed to indicate the readiness of the fetal lungs for breathing air after birth. An LS ratio greater than 2:1 was considered indicative of fetal lung maturity. However, this method had its limitations, as factors like maternal diabetes could affect the accuracy of the results.

With advancements in medical understanding, it was realized that the LS ratio was not always a reliable predictor of lung maturity. Instead, other tests such as lamellar body counts and phosphatidylglycerol testing have emerged as more accurate indicators of fetal lung development, rendering the LS ratio less relevant in modern OB-GYN practice.

3. Maternal Serum Alpha-Fetoprotein (MSAFP) Level Checkings

Maternal serum alpha-fetoprotein (MSAFP) level checking was a screening test used to detect potential neural tube defects and chromosomal abnormalities in the fetus. The MSAFP level in the maternal blood was measured, and abnormal levels were associated with an increased risk of conditions like spina bifida and anencephaly. While MSAFP testing provided valuable information, it was a screening tool and not a diagnostic test.

Today, prenatal screening has evolved to include more comprehensive tests like cell-free DNA testing and ultrasound scans. These tests offer greater accuracy in detecting a wider range of fetal abnormalities, including Down syndrome and other chromosomal conditions, reducing the reliance on MSAFP level checking alone.

4. Wet Preps

Wet preps, a microscopic examination of vaginal secretions, were once used to diagnose vaginal infections and identify the presence of various microorganisms, including yeast and bacteria. This technique involved placing a sample of vaginal discharge on a microscope slide, adding a drop of saline solution, and examining the slide under a microscope. While wet preps could provide valuable information, they had limitations in terms of sensitivity and specificity.

Modern OB-GYN practice now relies on more accurate methods such as nucleic acid amplification tests (NAATs) and cultures to diagnose vaginal infections. These tests offer improved accuracy in identifying specific pathogens and guiding appropriate treatment.

The landscape of OB-GYN has transformed significantly over the years, thanks to advancements in medical science and technology. While techniques like fetal scalp sampling, LS ratios, MSAFP level checking, and wet preps were once instrumental in providing healthcare insights, they have been largely replaced by more accurate, efficient, and less invasive methods. As the field continues to evolve, these changes underscore the importance of staying up-to-date with the latest practices and technologies in providing optimal care to pregnant individuals and women's health.

 

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