24 Jan

Steamboat Perinatal Conference

Inventor of PeriGen advanced fetal monitoring

Once again, PeriGen’s Senior Vice President of Clinical Research, Dr. Emily Hamilton, and Chief Medical Officer, Dr. Thomas Garite, presented at the annual Steamboat Perinatal Conference in Colorado.  Dr. Garite’s presentation titled “The New Labor Guidelines: Benefit or Harm” incited much discussion as did Dr. Hamilton’s review of the importance of precision when looking fetal heart rate deceleration area.

Dr. Hamilton’s presentation, titled “Fetal Heart Rate Deceleration Area: Size Matters,”  reviewed the literature related to both the widespread inconsistency in fetal heart rate assessments, the impact this has on outcomes, and the many challenges associated with “typing” decelerations.  Much of her paper focused on a suggested, alternative methodology using deceleration area/time.

Her presentation slides are now available by clicking here

The annual Steamboat Perinatal Conference, now in its 32nd year, addresses current and controversial topics in perinatal care.  The faculty is drawn from both active practitioners and clinical researchers.  Although, like most conferences, the event centers around scheduled lectures, the Steamboat Perinatal Conference is best known for the animated discussions among faculty and attendees that happen during and after sessions.

08 Nov

Recommended Reading: A Profile of Friedman

Recommended Reading A Profile of Emanuel A. Friedman*

Dr. Emanuel A. Friedman, father of the labor curveEvery practitioner and student of obstetrics owes much to the landmark works of Emmanuel A Friedman. Recently, Dr. Romero, Editor in Chief of the American Journal of Obstetrics and Gynecology, interviewed Dr. Friedman and has chronicled his remarkable story for us. As with many discoveries or inventions, Dr. Friedman’s creative journey was triggered by happenstance and adversity.

While we may debate the merits and shortcomings of the mathematical techniques available in that era, especially when compared with the mathematical methods available today, no one can question how Dr. Friedman raised the level of thinking about labor by a quantum leap. I treasure an autographed copy of his 1955 publication entitled Primigravid Labor; a graphicostatistical analysis.

I highly recommend Dr. Romero’s essay on one of our great obstetrical thinkers.

*Romero R. A profile of Emanuel A. Friedman, MD, DMedSci. Am J Obstet Gynecol. 2016 Oct;215(4):413-4. doi: 10.1016/j.ajog.2016.07.034. Epub 2016 Aug 3.

27 Sep

My Post-Summer Research Reading List

In The myths and physiology surrounding intrapartum decelerations: the critical role of the peripheral chemoreflex published in the Journal of Physiology, Lear et al have written a highly readable and methodical analysis of current evidence about the mechanisms of fetal heart rate decelerations. This is a must read for anyone seriously using fetal monitoring. He challenges long held tenets and presents a simplified coherent approach to the interpretation of heart rate monitoring. Here are two excerpts that may compel you to read further:

“… Despite multiple detailed analyses, there is no consistent FHR marker of fetal compromise …”

“… We believe that it is better to focus on the frequency, depth and total duration of decelerations during labor rather than on timing, shape or supposed aetiology of the specific deceleration.”

In an article published recently in the American Journal of Obstetrics & Gynecology titled Triggers, bundles, protocols, and checklists — what every maternal care provider needs to know, Arora et al define and provide examples of various methods to standardize and streamline clinical care and summarize the evidence supporting their association with improved outcomes. Many examples are provided for obstetrical issues such as hemorrhage, hypertension, oxytocin usage or preop preparation. With burgeoning evidence from diverse medical and non-medical domains, the question is no longer “Do these methods work?“, but rather “How can we get wider adoption and sustain compliance?” In short, how do we actually change established clinical beliefs and behaviors? This article is less informative on these practical issues.

InfluencerThere is abundant data about effective ways to change behavior. In short, behaviors will not change without aligning a critical mass of influential factors. Determination and good intentions alone are insufficient and depending upon them alone is destined to fail. To supplement this review of available obstetrical safety packages we strongly recommend the book- Influencer: The New Science of Leading Change, Second Edition by David Maxfield, Ron McMillan, Al Switzler. (Click here to see a summary of this excellent work)

19 Nov

New AJOG Articles

PeriGen’s Clinical Research

Team Just Got the Good

News: Two New Research

Articles Published in AJOG

Inventor of PeriGen advanced fetal monitoringEmily Hamilton and the rest of the clinical research team are thrilled to hear that two of their research papers – one on assessing dilation & descent – have been accepted for publication by the much-respected American Journal of Obstetrics & Gynecology (AJOG).

Emily is reviewing the research done by the team on the first paper next month during a brief  lunchtime webinar on December 2nd titled “Rethinking the Labor Curve.”  To register, complete the form below today.

Traditional methods for measuring labor progress have relied only on dilation and descent over time. The PeriGen team, joined by Samuel Smith MD and Kathleen Collins RN, both of PeriCALM customer MedStar, have identified a more discriminating method, one that uses multifactorial analysis to measure labor progress more reliably to enable improved intervention decisions.

The two papers published online (soon to be included in the next paper issue) by the American Journal of Obstetrics & Gynecology (AJOG) are:

The mathematic model tested for the published research is the foundation of PeriGen’s integrated labor curve software, PeriCALM® Curve™.  Part of the PeriCALM suite of perinatal analysis software, Curve provides clinicians a graphical display of labor progress at the bedside or remotely.  This display includes a comparison to the expected range of dilation from a normal reference population.  The labor progress comparison is presented graphically and numerically via percentiles to provide a precise quantitative and personalized assessment of dilation.  At each examination the comparison is updated to adapt to current labor conditions.

PeriCALM Curve benefits include:

  • Consistent visualization and measurement of labor progress
  • Tracks the effect of interventions in real-time, at-a-glance
  • Automatic adjustments for nulliparity/multiparity status


07 Oct

The PeriGen Journey

PeriGen featured in One Million by One Million Blog

The PeriGen Journey

During last week’s interview with Sramana Mitra,  the founder of One Million by One Million, Emily Hamilton outlined the long, often winding journey taken from her seed research into labor progress at McGill University to the forming of PeriGen to today’s fast growth as more and more hospitals realize the patient safety benefits of applying advanced technology to labor & delivery patient care.

She detailed how McGill’s mission of enabling world-class expertise and her love of “tinkering” led to government funding for the collaboration of a group of mathematicians, engineers, and clinicians that developed a totally new method — a mathematical model — for measuring labor progress, one designed to assess whether progress is normal or significantly abnormal to require intervention.

Emily describes how the new product was tested in her own backyard in Canada where almost all Montreal hospitals tested and then rolled out the prototype.  The hard part came with the attempt to extend reach into the Unites States.

“It certainly was harder when I stepped outside of my backyard.  With novel ideas, there’s a fair bit of skepticism as well.  Obstetrics has a lot of medico-legal pressures so there’s a lot of fear of doing anything that’s new,” explains Emily.

Enter PeriGen

Joining Emily Hamilton during the One Million by One Million interview, Matthew Sappern (PeriGen’s CEO) explained the next leg of the journey.

“PeriGen is actually the combination of a company called E&C Medical, originally based in Tel Aviv, and LMS, Emily’s company in Canada.  E&C was trying to do pretty much what Emily’s team was rolling out.    The companies were brought together under the name PeriGen to offer their compelling technologies within the US market,” says Matthew.

The combination has proved to be a powerful one.  Under Matt’s leadership, PeriGen has gained avid evangelists for their technology among the obstetric and investing communities.  The result has been significant growth and a remarkable level of traction, especially in the last 18 months.

Click to read the entire interview on One Million by One Million