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November 9, 2016

Improved handling of dysfunctional labour confirmed by article in PLOS ONE

September 28, 2016

Tartu University Hospital introduces unique clinical solution to help women with dysfunctional labour during childbirth.

July 15, 2016

Interview with Dr. Susanna Timonen, Turku University Hospital in Turku, Finland.

April 14, 2016

AFL™ metoden ska förhindra långdragna förlossningar.

April 7, 2016

Södersjukhuset inför unik metod för att minska antalet långdragna förlossningar

February 16, 2016

Swecare Foundation has published an article about Obstecare in their blog.

Improved handling of dysfunctional labour confirmed by article in PLOS ONE

An article published in PLOS ONE (published online 26 October, 2016, doi: 10.1371/journal.pone.0161546) concludes that measuring lactate in amniotic fluid (AFL) is a good predictor of delivery outcome in arrested deliveries. Low levels of AFL may support the decision to continue a prolonged vaginal labour by augmentation with oxytocin. A high level of AFL correlates with operative interventions and post-partum complications.

The study was performed in four different countries (France, Sweden, Switzerland and Tanzania) and included 3000 delivering women. In the study, primiparous women all with a singleton pregnancy, gestational age 37 to 42 weeks and no maternal /fetal chronic and/or pregnancy-related conditions were included. A spontaneous onset of labour, regular contractions and cervical dilation ≥ 3 cm was also required.

AFL was measured using a point of care device (LMU061) from ObsteCare. The only device on the market that is regulatory approved for measuring lactate in amniotic fluid during labour. The study was part-financed by the Bill and Melinda Gates Foundation.

These findings confirm earlier findings that AFL can be used as a good bedside tool when treating women suffering from a dysfunctional delivery. By using AFL monitoring in combination with Oxytocin infusion, the frequency of operative deliveries can be reduced and delivery times be optimized.

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Tartu University Hospital introduces unique clinical solution to help women with

dysfunctional labour during childbirth.

Tartu University Hospital introduces a unique clinical method, AFL-monitoring, to help women with dysfunctional labour and with the potential to avoid unnecessary caesarian sections. With the AFL-method, lactate level in the amniotic fluid (AFL) is monitored during labour. The AFL-level gives important information about the status of the uterine muscle, helping clinicians make the best decisions for mother and child. The method was introduced at the Women’s Clinic of Tartu University Hospital early June 2016.

Dysfunctional labour is a term describing a slow progressing delivery process and can be caused by inadequate contractions of the uterus. In many cases it will result in interventions, caesarean sections, vacuum or forceps, instead of a spontaneous vaginal delivery. Interventions always increase the risk for complications for both the mother and child and must be avoided if possible.

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For the first time it is now possible to monitor the status of the uterus during labour and the effect on the delivery process. The AFL-method is a Point-of-Care solution that is quick and easy to use and non-invasive. It has been developed by the Swedish company Obstecare AB and is based on ground-breaking research at the Karolinska Institute in Stockholm, Sweden.

“We are very enthusiastic about the implementation of AFL-method in our clinic.” “Since the start early this summer we have been able to avoid some Caesarian sections thanks to the new method” says Doctor Fred Kirss MD, Head of Department of Obstetrics.

About Tartu University Hospital

Tartu University Hospital is, with its 965 beds and almost 500 000 outpatient visits per year, the largest provider of medical care in Estonia and is the only university hospital in the country. The university was founded in 1632 by the Swedish King Gustav II Adolf. The obstetrics department in the Woman’s Clinic has about 2 500 births annually.

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Interview with Dr. Susanna Timonen, Turku University Hospital in Turku, Finland.

One of the centers where the AFL method is used is Turku University Hospital in Turku, Finland. We have interviewed Su-sanna Timonen, MD PhD, who has been one of the pioneering users, and discussed her experiences with the AFL method in her clinic.

Dr. Timonen, when did you start using the AFL method and what is your ex-perience so far?

We started about one and a half year ago. For the first time we can now pay more specific attention to the status of the uterus during labor. It is actually interesting how little we know about the function of the uterus during childbirth. The contractions during labor cause changes to the otherwise quite stable environment of the fetus. Therefore, it’s very important to understand what effect the contractions have on the baby.

For the uterus, labor is like a marathon. The uterine muscle becomes gradually more exhausted over time, in particular if it is forced to work

too intensively without resting. With the use of oxytocin, the risk for overload is increased and the muscle may become completely exhausted before the baby is delivered. The same could happen with us if we were forced to run a marathon too fast: we would be completely exhausted before even reaching the finish line. Before the AFL method was introduced we had no possibility to monitor the work load of the uterus.

What is from your point of view unique with the AFL method?

As pointed out, this is the first time we can really measure what’s happening with the uterus during labor. Today we use oxytocin extensively and thereby increase the risk of overloading the uterus. With the AFL method we can monitor the stress of the uterine muscle and administer oxytocin correctly.

Susanna-Timonen-2016-mars-9.JPGSusanna Timonen, MD PhD,

Turku University Hospital

Can you please share some experiences using the AFL method in your department?

My clinic is in a large university hospital with many doctors and midwives. The implementation of a new method takes time and requires repetitive training sessions. This method is simple to use and the physiology behind it is rather easy to understand. By reviewing our own cases we are able to discuss the importance of the measurements and learn how to understand the AFL method better and make it more familiar to the staff.

Can you briefly explain in your words the correlation between oxytocin and the AFL method? In other words, how would you use the AFL method together with oxytocin?

Oxytocin is a potentially dangerous drug if it is used incorrectly. Today one could argue that we are using it quite uncontrolled. In some delivery units in Finland more than 75% of patients are stimulated with oxytocin. It is not always a benefit for the baby to rush the birth process. Too strong and extended contractions compromise fetal oxygen supply and increase the risk of asphyxia. For the uterus, abnormal contractions increase the risk of exhaustion and thereby the risk of a prolonged or halted progress of delivery.

By using the AFL method, we can control the ability of the uterine muscle to contract and administer oxytocin properly. If the mother has spontaneous contractions but there is no progress, we consider measuring AFL before starting oxytocin. If we have used oxytocin and there is still no progress, we will check the AFL value. If the value is high, we stop oxytocin and wait for 1-2 hours. If the value is then normalized, we start oxytocin again if the delivery is not progressing. If the value is low, we can increase the oxytocin dose if necessary.

Can you please give us some examples of childbirth injuries which may be prevented by using the AFL method?

High AFL values are a risk for the baby’s wellbeing. Too strong and extended contractions impair uteroplacental circulation and thereby reduce fetal oxygen supply, which may lead to asphyxia. Furthermore, if the uterus becomes exhausted before the baby is born, it cannot push the fetus properly and the risk of operative delivery is increased.

Vacuum, forceps and cesarean section increase the risk of complications for both the baby and the mother. If we can avoid unnecessary interventions by using the AFL method, we can reduce the risk of injuries for both the baby and the mother.

Final question, can you please give your most important recommendation when using the AFL method?

Make the first AFL measurement when you consider starting to give oxytocin. During the continued augmentation, if there is no progress, continue to measure AFL. Use the published reference values to decide your actions. If the value is low, you can increase the oxytocin dosage. If the value is high, stop oxytocin and wait. If the value is then normalized, start oxytocin again if there is no progress. If the value is still high, consider an operative delivery.

Download the interview as pdf >>

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April 14, 2016

AFL™ metoden ska förhindra långdragna förlossningar.

Långa förlossningar kan medföra komplikationer för både barnet och mamman. Nu har Södersjukhuset tagit fram en ny metod som kan minska problemet.

SVT Nyheter intervjuar Dr Eva Wiberg-Itzel.

Se inslaget här>>

April 7, 2016                                                                                                                     ↑ TOP

Södersjukhuset inför unik metod för att minska antalet långdragna förlossningar.

En förlossning som tar tid kan leda till skador på både den födande kvinnan och barnet. En av de vanligaste orsakerna till att en förlossning drar ut på tiden är svaga värkar. Förlossningen på Södersjukhuset inför nu en ny unik metod för att undvika långdragna förlossningar.

Läs Södersjukhusets pressmeddelande här>>

Läs artikel i Dagens Nyheter från 2016-03-17 här >>

Se inslag i Sveriges Television från 2016-04-06 här>>

February 16, 2016                                                                                                            ↑ TOP

Swecare Foundation has published an article about Obstecare in their blog.

Swecare is a body, bringing industry, life science and healthcare together.

Read the blog (in Swedish) and learn more about us.

             

Obstecare AB

Karolinska Institutet Science Park

Fogdevreten 2

SE 171 65 SOLNA

Sweden

© 2017 Obstecare AB

Telephone:  +46 8 751 56 27

E-mail:         info@obstecare.com

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AFL monitoring system is currently not commercially available in the United States

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