Approximately 1200 healthy term babies in the UK each year are starved of oxygen during labour. A proportion of them die during or shortly after labour, but majority live with permanent brain injury and a range of devastating complications.
Studying the relationship between fetal heart rate and fetal health prior to and during labour to prevent fetal compromise. The goal is to provide at the bedside much needed evidence-based fetal monitoring. Before labour, 6 in 1000 babies are delivered urgently based on the fetal monitoring. During labour, this number is 74 in 1000 babies.
what we do
The Oxford Centre for Fetal Monitoring Technologies was born in the early 2012 as a natural umbrella for the relevant work in the Nuffield Department of Women's & Reproductive Health spanning over 30 years.
The team is also based at the Big Data Institute and collaborates with the Institute of Biomedical Engineering and Huntleigh Healthcare (an industrial partner). The research is partially funded by the National Institute for Health Research (NIHR).
We host a Signal Processing and Monitoring (SPaM) in Labour workshop, which is a bi-annual event, held since 2015. It is an exciting initiative to bring together experts in labour monitoring and fetal heart rate analysis to critically review and discuss current issues such as: new technology; comprehensive digital databases; statistical analysis; classification; clinical practice, fetal physiology and challenges. Read more here.
Monitoring before labour (Antepartum)
Electronic fetal heart rate monitoring was introduced in 1966 for use in labour. The technique was then successfully applied to monitoring the distressed fetus before labour. It was quickly appreciated that it generated errors due to the unstandardised process of visual assessment of complex patterns. This led to the development of the Oxford Dawes Redman computerised system for objective numerical recognition of important abnormal features. It is now marketed by Huntleigh Healthcare as Sonicaid FetalCare and Sonicaid Team. The system has been developed and validated on a large archive of antenatal traces linked to clinical outcome data.
MONITORING during LABOUR (intraPARTUM)
We can listen to the fetal heart rate through a stethoscope or an electronic monitor. Fetal monitoring is the core of standard fetal monitoring both before and during labour. Electronic monitoring produces a continuous paper strip, showing graphs of the fetal heart rate and of uterine contractions, which change with time (time-series). In labour, the response of the fetal heart rate to contractions is of particular importance.
During birth, the stress of contractions and descent through the birth canal can reduce a baby’s oxygen supply. Most babies are resilient and cope but 0.5% suffer birth asphyxia (suffocation), of which, 250 babies in the UK die each year. Those who survive asphyxia may suffer convulsions and permanent brain damage. Such babies must be detected and rescued by urgent delivery. Diagnosis of fetal distress depends mostly on the paper record of the fetal heart taken electronically during labour (Cardiotocogram, CTG). The complicated patterns are assessed by eye, which is error-prone and unreliable. Even experts disagree with each other or with themselves when reviewing the same trace at different times. Such uncertainty causes ‘fail-safe’ decisions and many unneeded Caesarean sections.
Image: Prototype device for data-driven real time intrapartum CTG analysis (OxSys 1.5, Georgieva et al. 2017).
We continue to enhance and improve the Dawe-Redman system to ensure its successful translation into better clinical practice. Increasing experience of rare events revealed by our large archive of records means that we can introduce and test improvements quickly and make them available to Huntleigh Healthcare.
We are developing better ways to monitor babies during labour. We use advanced signal processing and data analystics to interrogate our large database of approximately 100,000 labours with digital CTGs linked to perinatal outcomes.
We are also researching if there are certain clinical factors, markers or symptoms (as well as new biomarkers in maternal blood) that can make fetal monitoring in labour more patient-specific and targeted.
Our goal is to translate the new findings into an evidence-based system for risk assessment during labour, the Oxford System (OxSys).