Fetal monitoring technologies for the detection of intrapartum hypoxia - challenges and opportunities

Abstract

Intrapartum foetal hypoxia is related to long-term morbidity and mortality of the foetus and the mother. Foetal surveillance is extremely important to minimize the adverse outcomes arising from foetal hypoxia during labour. Several methods have been used in current clinical practice to monitor foetal well-being. For instance, biophysical technologies including cardiotocography, ST-analysis adjunct to cardiotocography, and Doppler ultrasound are used for intrapartum foetal monitoring. However, these technologies result in a high false-positive rate and increased obstetric interventions during labour. Alternatively, biochemical-based technologies including foetal scalp blood sampling and foetal pulse oximetry are used to identify metabolic acidosis and oxygen deprivation resulting from foetal hypoxia. These technologies neither improve clinical outcomes nor reduce unnecessary interventions during labour. Also, there is a need to link the physiological changes during foetal hypoxia to foetal monitoring technologies. The objective of this article is to assess the clinical background of foetal hypoxia and to review existing monitoring technologies for the detection and monitoring of foetal hypoxia. A comprehensive review has been made to predict foetal hypoxia using computational and machine-learning algorithms. The detection of more specific biomarkers or new sensing technologies is also reviewed which may help in the enhancement of the reliability of continuous foetal monitoring and may result in the accurate detection of intrapartum foetal hypoxia.

Feasibility Analysis of ECG-Based pH Estimation for Asphyxia Detection in Neonates

“…Additionally, in this study, only one parameter (pH value) was considered for acid-base characterization. However, other parameters including base excess (BE), lactate, partial pressure of O 2 (pO 2 ), partial pressure of CO 2 (pCO 2 ), and bicarbonate (HCO 3 − ) can play an important role in determining the metabolic disorders in neonates [ 22 , 76 ]. Due to the unavailability of complete demographic information, the statistical analysis for demographic variables such as gender, gestational age, birth weight, and mode of delivery was not performed in this study.…”

“…Additionally, the accuracy of PO (which is below 80%) is limited in determining the oxygen level in tissues [ 20 ]. Furthermore, pulse oximetry does not provide information about the metabolic changes occurring in the neonate or the specific cause of oxygen deprivation [ 21 , 22 ]. tcPO2 measures the partial pressure of oxygen through the skin.…”

“…tcPO2 measures the partial pressure of oxygen through the skin. However, this test is influenced by the skin thickness, temperature, and how much contact gel is used, resulting in erroneous and false readings [ 17 , 22 ]. Additionally, PO and tcPO2 do not provide any information about the metabolic disorder, making blood gas analysis necessary to find metabolic anomalies in asphyxiated neonates [ 23 ].…”