Lyuba Bozhilova

During labour the fetus undergoes hypoxic stress. In rare cases, this can lead to brain injury and even death. Cardiotocography (CTG) is widely used to monitor fetal heart rate and to assess fetal wellbeing in labour. However, accurate and timely interpretation of CTG traces is challenging, and the evidence for CTG efficacy in preventing brain injury remains mixed.

At Oxford Labour Monitoring, we develop data-driven digital tools for real-time risk assessment close to labour onset. Our algorithms are based on over 100,000 maternity records and combine fetal heart rate features extracted from the CTG, together with routinely collected maternity data. As a maternity data scientist, my interest in labour care spans three areas: 

Prognostic models using CTG data Can we identify, close to labour onset, at-risk fetuses that are most likely to struggle, in order to expedite their delivery and minimise the risk of brain injury? Conversely, when labour is progressing safely, can we reassure the birthing person and their clinicians, so they can make informed choices about their care and avoid unnecessary and unplanned interventions? 

Changes in maternity demographics and clinical care Who gives birth and how they give birth has changed significantly over the past thirty years. People giving birth in Britain now are older, and more likely to be diagnosed with conditions such as pregnancy-induced hypertension or gestational diabetes. However, they are also more likely to receive appropriate care for these conditions, are less likely to smoke, and are less likely to have a growth-restricted fetus, compared to the previous generation. Our understanding of clinical risk in labour is inevitably based on historical data, which does not always reflect the contemporary labouring demographic and their needs. I am interested in how we use routinely collected maternity data to update our understanding of clinical risk to match what happens in the contemporary labour ward.

Evidence-based maternity triage CTG monitoring is contraindicated in low-risk labour, as studies show it significantly increases the chance of operative delivery without meaningfully improving outcomes. In the UK, around half of labours are considered low-risk and are not continuously monitored with CTG, and half are considered higher-risk and are monitored. However, different guidelines and practices exist for evaluating risk and deciding who will benefit most from CTG monitoring. By analysing large maternity cohorts, we can quantify and improve risk assessment at the point of triage, so people in labour get the most appropriate care.