Are we seeing the end of an era? - the death of the Pinard. Why do I say this? in the latest clinical guidelines for Intrapartum Fetal surveillance (2006) The Royal Australian and New Zealand College of Obstetricians an Gynaecologists (RANZCOG)have sounded the death knock for the pinard. Guideline 7 "intermittent auscultation should be performed using Doppler ultrasound rather than a Pinard stethocope" Guideline 8 "auscultation should occur with Doppler signal on speaker mode". Since the publication of these guidelines, I have seen the disapearance of all the pinard on our labour and birth suite, which has promted me to ask the question? are we loosing the art and skill of using the pinard?
It is interesting to note that in the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI)2005, this report recommended training for midwives and junior doctors in CTG interpretation, because errors were being made which had a detrimental effects for both woman and baby. The question is asked what about senior doctors? who monitors them? CTG monitoring is technology spreading without justifed research.
It is a well know fact that CTG monitoring is not an exact science, however in the current litigatous climate it is the best we have and clinicans are inclined to feel protected by using this technology, even though you can have several clinicans disagreeing on the interpretation of the CTG.
Mahomed et al. (1994, pp 497-500) conducted a randomised controlled trial on the effectiveness of differnet methods of intrapartum monitoring. They found that the doppler sonicad compared with the pinard stethoscope was better at detecting abnormalities in the fetal heart rate. They also found that the pinard was more uncomfortable for the woman.
The doppler sonicad is the electronic equivalent of the pinard and has the advantage of the woman being able to hear the babys heart rate, and further protecting the midwife against litgation (Seymoour, 1995, p 47).
So is there still a place for the pinard stethoscope?
I would like to see midwives teaching students how to use the pinard again in conjuction with the doppler, so that we maintain the midwifery skill, you never know if technology fails we are still able to monitor the fetal heart.
Ayres-de-Campos D, et al. Inconsistencies in classification by experts of cardiotocograms and subsequent clinical decision, Br J Obs Gyn, 1999: 106; 1307-1310.
RANZCOG Intrapartum Fetal Survellance Clincial Guidelins. 2nd edition. 2006
Seymour, J. (1995). Fetal monitoring.