Apoorva Bommareddy

We began our first week of clinical immersion on the Labor & Delivery floor with 7 a.m. sign-out. The residents reviewed postpartum patients and those currently on the labor board. We then joined them on rounds, where they used a portable ultrasound to assess the position of the baby’s head. As a first-time observer, interpreting the ultrasound was difficult—it mostly looked like a gray blob, and I couldn’t distinguish features like the head or eyes. The process moved quickly, and I wondered whether patients themselves had time to understand what was being shown.

We also observed the placement of a Foley balloon catheter for labor induction. Its purpose is to help dilate the cervix, often in combination with misoprostol (miso). The procedure looked quite uncomfortable but it seemed to be a routine procedure.

Later, we checked on a postpartum patient with significant blood loss. A pressure bandage had been applied, but when it was removed—without adhesive removal cream, as protocol recommends—the patient experienced what she described as “worse than a carpet burn.” It was a small but important example of how process lapses can cause unnecessary discomfort.

The highlight of the week was observing a C-section—my first time witnessing a delivery. I wasn’t sure how I’d respond to the blood or surgical exposure, but the moment was incredibly exciting. Watching the layers of tissue being cut, the unexpected foot-first delivery, and the father’s emotional reaction made the C-section both intense and unforgettable.

Good Design: Stryker Triton SurgiCount+ Blood Loss Monitoring System

A (Activity): This device quantifies estimated blood loss (EBL) in real time during surgery, particularly during C-sections.
E (Environment): The system is used in the operating room, adjacent to the sterile field.
I (Interaction): As surgeons pass blood-soaked laparotomy sponges to the scrub nurse, a tech or circulating nurse scans them using the machine. The system calculates how much blood each sponge absorbed.
O (Objects): The core elements are the absorbent cloths, the scanning machine, and the collection bin. The scanner distinguishes sponges by type and integrates data into a cumulative blood loss estimate.
U (Users): The main users are the surgical team, including scrub nurses, circulating nurses, surgical techs, and surgeons.

Bad Design: Pressure Bandage Removal Process in Postpartum Care

A (Activity): Managing and removing pressure dressings applied to the perineal area following significant postpartum bleeding.
E (Environment): Postpartum recovery rooms, where nurses care for patients recovering from vaginal or C-section deliveries.
I (Interaction): Nurses or staff remove the pressure bandage during routine checks or transitions of care. Protocol recommends using adhesive removal cream to avoid damaging sensitive skin, but in this instance, it was not used.
O (Objects): The pressure bandage (typically an adhesive dressing), adhesive removal cream (intended for pain-free removal)
U (Users): Postpartum nurses, physicians and patients

This week I was in the Maternal Fetal Medicine (MFM) clinic. MFM is a subspecialty of obstetrics that focuses on managing high-risk pregnancies, including patients with chronic conditions such as hypertension and diabetes, multiple gestations, fetal anomalies, or a history of complications. We observed many routine prenatal visits, as well as counseling sessions for high-risk patients. A major focus was understanding the structure and expectations of each trimester’s visits, especially what is standardly done and what additional monitoring is added based on risk.

At many visits, patients received various types of ultrasound evaluations, such as dating scans and anatomy scans. A quick, non-invasive method commonly used to check fetal heart rate (FHR) was the handheld Doppler ultrasound. Unlike the large-screen ultrasounds used for fetal measurements and imaging, this device only displayed the heart rate in real time and played the fetal heartbeat as audio.

The purpose of this Doppler ultrasound is to confirm the presence and general well-being of the fetus by verifying fetal cardiac activity and rate. It is quick, portable, and low-cost, making it suitable for routine check-ins during prenatal visits. However, I became curious about its accuracy, especially since no waveform or heart rate trend is visualized.

A 2019 study (Doppler Ultrasound Technology for Fetal Heart Rate Monitoring: A Review) evaluated the accuracy of handheld Doppler devices compared to traditional cardiotocography (CTG). The study concluded that while Dopplers are accurate for basic FHR detection, they are limited in detecting variability, accelerations, or decelerations, which are essential for assessing fetal distress. The study emphasized that handheld Dopplers are best suited for intermittent auscultation, not continuous monitoring or risk stratification.

This gap in functionality has led to innovation in the form of smart, connected Doppler devices. One such advancement is being developed by HeraMed with their device HeraBEAT (Patent US20200163644A1), which covers a wearable fetal heart rate monitor with smartphone connectivity. This device allows home-based FHR monitoring, real-time audio feedback, and data transmission to healthcare providers. The technology uses Bluetooth communication and cloud-based data storage, offering improved access to fetal health data and the potential to enhance telemedicine in obstetrics. This direction highlights an opportunity to integrate Doppler usability with data tracking, trend visualization, and remote care capabilities.

MFM Clinic

Storyboard for hemorrhage during pregnancy