A. M. Fischer

and 4 more

Objective This work explores the perceptions of obstetric clinicians about Artificial Intelligence (AI) in order to bridge the gap in uptake of AI between research and medical practice. Identifying potential areas where AI can contribute to clinical practice, enables AI research to align with the needs of clinicians and ultimately patients. Design Qualitative interview study. Setting A national study conducted in the Netherlands. Sample Dutch clinicians working in obstetrics with varying relevant work experience, gender, and age. Methods Thematic analysis of qualitative interview transcripts. Results Thirteen gynaecologists were interviewed about hypothetical scenarios of an implemented AI model. Thematic analysis identified two major themes: perceived usefulness and trust. Usefulness involved AI extending human brain capacity in complex pattern recognition and information processing, reducing contextual influence, and saving time. Trust required validation, explainability and successful personal experience. This result shows two paradoxes: firstly, AI is expected to provide added value by surpassing human capabilities, yet also a need to understand the parameters and their influence on predictions for trust and adoption was expressed. Secondly, participants recognised the value of incorporating numerous parameters into a model, but they also believed that certain contextual factors should only be considered by humans, as it would be undesirable for AI models to utilize that information. Conclusions Obstetricians’ opinions on the potential value of AI highlight the need for clinician-AI researcher collaboration. Trust can be built through conventional means like RCTs and guidelines. Holistic impact metrics, such as changes in workflow, not just clinical outcomes, should guide AI model development. Further research is needed for evaluating evolving AI systems beyond traditional validation methods.

C.E. Tacke

and 7 more

Objective: To investigate trends in low 5-minute Apgar scores in (near) term singletons. Design: Nationwide cohort study. Setting: The Netherlands. Population: A cohort of 1,583,188 singletons liveborn between 35 +0 and 42 +6 weeks of gestation in the period 2010-2019 from the Dutch Perinatal Registry. Methods: We studied trends using Cochrane-Armitage trend tests. Risk factors were studied by logistic regression analysis and Population Attributable Risk (PAR) calculation. Main outcome measures: Low 5-minute Apgar score (<7 and <4) as primary outcome. Results: The proportion of infants with low 5-minute Apgar score <7 and <4 increased significantly between 2010 and 2019 (1.04-1.42% (p<0.001), 0.17-0.19% (p=0.009), respectively). While neonatal mortality remained unchanged, NICU admissions and low umbilical artery pH’s increased significantly. Many perinatal characteristics showed a significant association with low Apgar scores. The highest risks were found for nulliparity, epidural analgesia, emergency caesarean section, instrumental vaginal delivery, prolonged second stage of labour, male sex and delivery in secondary care. The obstetric interventions induction of labour, epidural analgesia and planned caesarean section showed an increasing trend. Instrumental vaginal delivery and emergency caesarean section were performed less frequently over time, however within these obstetric intervention subgroups the highest increase in low Apgar scores was observed. Conclusions In the Netherlands, the risk of a low 5-minute Apgar score increased significantly over the last decade, with the highest increase being observed in the obstetric intervention subgroups of instrumental vaginal delivery and emergency caesarean section. Neonatal mortality remained stable over the study period.