Patient perspectives on telemonitoring in low- and high-risk pregnancies: A feasibility study using a wireless fetal heart rate monitor.

Fetal monitoring in pregnancies at and beyond 41 completed weeks: Prospective blind observational study of the use of umbilical and middle cerebral artery Doppler.

Background This study aimed to determine how obstetricians’ knowledge of T18 influences their attitudes toward the antepartum, intrapartum, and postpartum management of T18 cases and to compare these attitudes with their approaches to trisomy 21 (T21) cases. These attitudes were analysed within the framework of the medical ethics principles of beneficence and autonomy. Methods This cross-sectional descriptive survey study was conducted between 1 February and 31 July 2021. Data from 194 of 388 participants who completed all questionnaire items were analysed. Results The study included specialists in obstetrics and gynecology (mean age: 47.8 ± 8.9 years; 56.2% female). 40.2% defined “lethal congenital malformation” as anomalies inevitably causing intrauterine death; 91.2% considered T18 “lethal” and 77.6% “incompatible with life.” For T18, 82.8% always recommended termination. When pregnancy continued, most acted in line with maternal wishes; 56.8% would prefer cesarean in fetal distress and 60.5% supported perinatal palliative care. For T21, 89.0% did not define it as lethal, 94.8% did not consider it incompatible with life, and only 57.1% always recommended termination. Multivariate analysis showed older age and religious beliefs predicted lower termination recommendation for T21; only religious beliefs predicted this for T18. Female obstetricians more often provided palliative care and fetal monitoring for T21. Conclusions This study reveals significant gaps and variability in knowledge, attitudes, and management strategies for prenatally diagnosed T18 among obstetricians in Turkey. Such variability may result in some women not being offered appropriate care options during pregnancy or delivery. More practical training and ethical guidance are needed for consistent, patient-centred care in fetal anomaly management.

The purpose of this study was to describe US nurses' perspectives and practices on maternal position changes during labor. We conducted a national survey of nurses working in labor and delivery units in the past year. The survey was disseminated through social media and email with snowball sampling. Our primary objective was to characterize the proportion of nurses using position changes during labor and nurses' reported indications for position changes. Secondary outcomes included the use of position change circuits and reasons position changes were not initiated. We used descriptive statistics to characterize responses and bivariate analyses to compare respondents who reported circuit use in their practice to those who did not. Among 498 respondents, 99% reported using maternal position changes during labor and 96% believed labor maneuvers are effective and improve outcomes. Nurses routinely reported using positional maneuvers for indications of slow labor progress, suspected occiput posterior, and suspected asynclitic fetal position. Commonly reported reasons for not using position changes included patient BMI, patient preference, fetal monitoring, and a lack of knowledge. Approximately two-thirds of nurses using maneuvers included a circuit of positions. Of the 20 listed maneuvers in the survey, seven were used by >50% of respondents and most likely to be used in a circuit of position changes. Use of circuits was more common among younger nurses. Region of the country was not a factor in use of circuits. Position changes are a frequently used intrapartum intervention with limited high-quality supporting evidence linking specific positions or circuits of positions to specific labor and birth outcomes. Further research is needed on the effectiveness of circuit-based position changes in labor, especially in cases of prolonged first stage of labor.

Background: Fetal monitoring plays a crucial role in reducing maternal and neonatal mortality, particularly in South Asian countries where healthcare disparities persist. This review examines recent advances in fetal monitoring technologies across South Asia, from traditional methods to artificial intelligence-driven solutions. The aim is to synthesize current evidence on fetal monitoring technologies implemented in South Asian countries (India, Pakistan, Bangladesh, Nepal, Bhutan, and Sri Lanka). Methods: A comprehensive literature search was conducted across PubMed, Google Scholar, and regional databases for publications from 2015-2024. Studies reporting on fetal monitoring technologies, implementation, and outcomes in South Asian countries were included. Results: Twenty-five studies were reviewed, covering traditional cardiotocography (CTG), portable ultrasound devices, telemedicine applications, and AI-based interpretation systems. India leads regional research with 14 studies, followed by Pakistan (4), Bangladesh (3), Nepal (2), and Sri Lanka (2). Key advances include mobile health (mHealth) platforms, low-cost Doppler devices, cloud-based CTG interpretation, and machine learning algorithms achieving 85-95% accuracy in fetal distress detection. Major challenges include limited infrastructure, inadequate training, and high costs. Conclusions: While significant technological progress has been made, implementation gaps persist across South Asia. Integration of AI-driven solutions with portable, affordable devices shows promise for improving access to quality fetal monitoring in resource-limited settings.

Objective: To summarize the clinical characteristics, management and short-term and long-term outcomes of pregnant women with chronic kidney disease (CKD) stage 4-5. Methods: The clinical data of pregnant women with CKD stage 4-5 admitted by the multidisciplinary team (MDT) of CKD pregnancy management in the Third Affiliated Hospital of Chongqing Medical University from September 2019 to July 2024 were collected and retrospectively analyzed, including medical history, laboratory examination, pregnancy outcome, treatment options, and renal function outcome. To summarize the experience of prenatal counseling, pregnancy management, dialysis indications and lifestyle intervention in pregnant women with CKD stage 4-5. Results: A total of 10 pregnant women with CKD stage 4-5 were enrolled, aged (29.0±4.2) years (range: 23 to 36 years). Among the 10 cases, 3 cases were induced abortion in the second trimester, 1 case had missed abortion in the first trimester, and 6 cases were finally delivered successfully. Renal biopsy was performed in 4 cases to determine the type of primary nephropathy, and genetic testing was performed in 4 cases to confirm the diagnosis of hereditary nephropathy. Among the six CKD stage 4-5 pregnant women who successfully delivered, three started dialysis treatment in the second and third trimesters of pregnancy, and the other three started dialysis treatment immediately, 5.5 months and 18.3 months after delivery, respectively. All pregnant women were terminated by cesarean section and none of them had postpartum hemorrhage. The gestational age at delivery was (33.8±1.1) weeks (range: 32+1 to 35+1 weeks). All neonates were premature, with no fetal death and neonatal death. Two cases were small for gestational age and the other four were appropriate for gestational age. The length of neonatal intensive care unit (NICU) stay was (23.0±11.0) days (range: 10 to 38 days). No serious complications occurred during NICU stay. All newborns grew and developed well during the follow-up period of 10-60 months. Conclusions: CKD stage 4-5 is not an absolute contraindication for pregnancy. Comprehensive evaluation of doctor-patient shared decision-making on the premise of sufficient doctor-patient communication, precise management of MDT, close maternal and fetal monitoring, lifestyle medical intervention and timely initiation of dialysis can help pregnant women with CKD stage 4-5 achieve safe pregnancy and good maternal and fetal outcomes.

The functional development of the fetal brain is critical for long-term health, yet current diagnostic tools lack the capability to examine it effectively. This paper presents a non-invasive method for extracting fetal brain signals using abdominal recordings obtained before elective cesarean sections, with neonatal brain activity recorded post-delivery serving as a reference. The recorded abdominal signals were preprocessed using digital filters and separated into independent components using the blind source separation technique: Independent component analysis. These components were analyzed to identify potential fetal brain signals based on their similarity to postnatal brain activity and dissimilarity to maternal cardiac signals, which are the primary source of interference in abdominal recordings. Features related to time and frequency characteristics were extracted, and a feature selection was conducted to identify the most informative ones. Preliminary results using simulated data demonstrated effective signal separation, with some segments closely resembling postnatal brain activity in spectral features. Low-frequency bands showed the strongest potential for distinguishing fetal brain activity from maternal interference. This approach demonstrates a feasible pathway for non-invasive fetal brain monitoring with implications for early detection of neurological development issues.

Background: Maternal perception of fetal movement is an important early indicator of fetal well-being, and reduced fetal movement (RFM) is often associated with fetal compromise. However, awareness and adherence to fetal movement monitoring remain low in many communities due to limited knowledge and insufficiently trained support personnel. Objective: This study aimed to evaluate the effectiveness of a capacity-building program designed to strengthen community health cadres in educating pregnant women to monitor fetal movements using the Cardiff Count-to-Ten method, and to assess improvements in maternal accuracy and consistency in daily monitoring Methods: Ten cadres were trained to educate twenty-five pregnant women to perform daily fetal movement counting using the Cardiff Count-to-Ten method. Results: Cadre demonstration skills increased significantly from 55.2 to 88.3. Maternal counting accuracy improved from 28% to 88%, and consistency from 36% to 84%. Three cases of reduced fetal movement were successfully identified and referred to midwives for timely clinical evaluation. Discussion: The findings show that skill-based training and mentoring effectively enhance cadres’ communication and demonstration abilities, which in turn improve maternal understanding and adherence to monitoring. These results align with existing evidence indicating that fetal movement awareness promotes earlier care seeking, though its impact depends on strong referral pathways and responsive clinical follow-up. Conclusion: Strengthening cadre capacity effectively improved maternal ability to detect fetal movement changes, supporting early identification of fetal distress.

Effect of using artificial intelligence chatbot about electronic fetal monitoring on maternity nursing students' performance.

Birth asphyxia remains a leading cause of neonatal mortality in low-resource settings, with Zambia reporting a rate of 24 deaths per 1,000 live births. Birth asphyxia accounts for over 20% of neonatal ICU admissions. This study aimed to determine its prevalence and risk factors to inform targeted interventions. We conducted a secondary data analysis of medical records at Livingstone University Teaching Hospital, Zambia, including 497 maternal–neonatal records of deliveries between 15 July 2024 and 31 March 2025. Data were abstracted from the Obstetrics and Gynaecology Department and Neonatal Intensive Care Unit between 1 and 20 April 2025 using REDCap. The primary outcome was birth asphyxia, defined as failure to establish spontaneous respiration with Apgar ≤5 at 5 minutes or hypoxic-ischemic encephalopathy. Maternal, obstetric, and neonatal demographic and clinical variables were collected. Bivariate and multivariable logistic regression were used to identify factors associated with birth asphyxia, with statistical significance set at p < 0.05. The prevalence of birth asphyxia was 6.8% (34/497). Significant correlates included eclampsia (adjusted odds ratio [AOR]=17.3; 95% CI:2.7-111.0; p = 0.002), foetal distress (AOR = 7.3; 95% CI:2.5-20.9; p < 0.001), and resuscitation with suction (AOR = 3.8; 95% CI:1.2–11.5; p = 0.018) or facial oxygen (AOR = 3.5; 95% CI:1.0-11.6; p = 0.044). Neonates requiring bag-mask ventilation had 65.6% asphyxia rates versus 5% without (p < 0.001). Post-term gestation (15.2% asphyxia) and abnormal foetal heart rates (28.6%) were also associated with higher risk. The 6.8% asphyxia prevalence at LUTH reflects regional disparities, with eclampsia and foetal distress being critical modifiable risks. Strengthening emergency obstetric care, foetal monitoring, and neonatal resuscitation capacity could reduce preventable cases. These findings underscore the need for context-specific strategies to improve perinatal outcomes in Zambia and similar settings.

Birth asphyxia remains a leading cause of neonatal mortality in low-resource settings, with Zambia reporting a rate of 24 deaths per 1,000 live births. Birth asphyxia accounts for over 20% of neonatal ICU admissions. This study aimed to determine its prevalence and risk factors to inform targeted interventions. We conducted a secondary data analysis of medical records at Livingstone University Teaching Hospital, Zambia, including 497 maternal-neonatal records of deliveries between 15 July 2024 and 31 March 2025. Data were abstracted from the Obstetrics and Gynaecology Department and Neonatal Intensive Care Unit between 1 and 20 April 2025 using REDCap. The primary outcome was birth asphyxia, defined as failure to establish spontaneous respiration with Apgar ≤5 at 5 minutes or hypoxic-ischemic encephalopathy. Maternal, obstetric, and neonatal demographic and clinical variables were collected. Bivariate and multivariable logistic regression were used to identify factors associated with birth asphyxia, with statistical significance set at p < 0.05. The prevalence of birth asphyxia was 6.8% (34/497). Significant correlates included eclampsia (adjusted odds ratio [AOR]=17.3; 95% CI:2.7-111.0; p = 0.002), foetal distress (AOR = 7.3; 95% CI:2.5-20.9; p < 0.001), and resuscitation with suction (AOR = 3.8; 95% CI:1.2-11.5; p = 0.018) or facial oxygen (AOR = 3.5; 95% CI:1.0-11.6; p = 0.044). Neonates requiring bag-mask ventilation had 65.6% asphyxia rates versus 5% without (p < 0.001). Post-term gestation (15.2% asphyxia) and abnormal foetal heart rates (28.6%) were also associated with higher risk. The 6.8% asphyxia prevalence at LUTH reflects regional disparities, with eclampsia and foetal distress being critical modifiable risks. Strengthening emergency obstetric care, foetal monitoring, and neonatal resuscitation capacity could reduce preventable cases. These findings underscore the need for context-specific strategies to improve perinatal outcomes in Zambia and similar settings.

"When it works well, it's great!": Midwives perspectives on the beltless non-invasive fetal electrocardiogram for women in larger bodies in labour.

Optical fibers with integrated robotic microstructures are promising for cutting-edge applications. However, the development of microbots on a fiber system for synergistic sensing and actuation is challenging. Herein, inspired from natural Bobbit worm, we report a tactile gripper-on-a-fiber system that integrates wave spring, planar reflector with a scattering cone and a smart gripper on a single-mode fiber. The wave spring fabricated via two-photon polymerization of SU-8 can convert the applied micro-force into detectable stretching or compression, serving as a Fabry-Perot interferences sensor. Additionally, a pH responsive gripper with SU-8 frames and bovine serum albumin muscles is integrated with the wave spring, forming the tactile gripper-on-a-fiber system. As a proof-of-concept, the tactile gripper-on-a-fiber system was employed for micro-object sorting, flexible micro-block assembly, synergistic prey detection/capture, the measurement of Young's modulus of zebrafish zygotes, and in-situ fetal movement monitoring, revealing great potential in biomedicine, precision manufacturing, minimally invasive and robotic surgery.

Perinatal mortality is a dismal aspect of fetal health over the world. Fetal health is a critical component of a sustainable nation. Cardiotocography (CTG) employed in the fetal health monitor to assess mother and fetal well-being during childbirth. Cardiotocograms monitor the heart rate at its baseline value during labor, ignoring the risk of perinatal before delivery. The classifier predicts CTG data, allowing obstetricians to observe and anticipate the fetus status. This classifier identifies fetal normal, suspicious and pathologic states, with the heart rate of baseline value involved indicating a difficult fetal. A CTG dataset contains 2126 recording from the UCI repository used for classification. The CTG data sets are preprocessed using Normalization and scaling techniques, and then the preprocessed input data is utilized to Artificial Neural Network (ANN) model construction for classifying the fetal health, which is normal, suspicious, and pathologic of the high risk of pregnancy during 32 and 33 weeks of observation. Further, the 5-fold cross-validation is applied to examine the proposed model is quantified by precision, recall, F-score, ROC curve generated for three classes. From the evaluation, the Tuned ANN attained accuracy as 92% outperforms the un-tuned ANN accuracy of 90%.

Abstract Placental chorangiomas are the most common benign tumors of the placenta. Although most are small and asymptomatic lesions, giant chorangiomas are associated with an increased risk of adverse maternal and fetal outcomes. Therefore, in those affected by giant placental chorangioma, early diagnosis and intensive fetal monitoring are indicated to screen for fetal compromise and intervene as indicated. In some cases, expectant management or supportive therapies may serve a role. In the setting of fetal compromise, definitive treatment aimed at devascularization of the tumor has been described to gain pregnancy latency and avoid the risks of preterm delivery. Although multiple treatment options have been described, the optimal management of giant placental chorangioma remains undetermined. This narrative review serves to review the definition, diagnosis and pathophysiology of chorangioma, associated pregnancy complications, proposed management, and possible treatment options.

Smallness for gestational age has been associated with an increased risk of neonatal/fetal adverse outcomes. The Healthcare Safety Investigation Branch has issued a safety recommendation aimed at improving fetal growth monitoring strategies and reducing risk for babies. The objective was to summarise available evidence to inform the Healthcare Safety Investigation Branch recommendation. The review comprised four research questions on: effects of fetal growth monitoring on neonatal/parental outcomes; effects of implementing fetal growth monitoring guidelines on neonatal/parental outcomes; accuracy of fetal growth monitoring strategies for predicting smallness for gestational age neonates/fetal growth restriction and factors affecting the accuracy of fetal growth monitoring strategies. Nineteen databases were searched from 2000 to March 2023 and were updated September 2023. Pregnant people with and without risk factors were included. Each review question had further eligibility criteria. For accuracy results, summary estimates of the sensitivity and specificity with 95% confidence intervals for the prediction of smallness for gestational age at delivery were calculated. Random-effects models were used for the meta-analysis of clinical outcomes. Further outcomes, including the results of risk of bias assessments, were summarised narratively. Fifty-eight studies (78 publications) were included in the review. Q1 - Antenatal identification of smallness for gestational age pregnancies was associated with increased rates of intervention (two retrospective cohort studies, n = 100, 198 and 2928), but the available evidence did not support an effect on stillbirths or neonatal outcomes. Q2 - Meta-analysis (three observational studies and one randomised controlled trial, n = 318,523) indicated that implementation of the Growth Assessment Protocol was associated with a reduction in the risk of stillbirth and risk ratio of 0.79 (95% confidence interval 0.74 to 0.84). Meta-analyses (one observational study and one randomised controlled trial, n = 11,978) indicated that Growth Assessment Protocol implementation was associated with a reduction in the risk of 5-minute Apgar score < 7, risk ratio of 0.78 (95% confidence interval 0.64 to 0.95); however, the effect estimate for neonatal intensive care unit admission was highly uncertain, 0.59 (95% confidence interval 0.02 to 20.03). Q3 (53 studies) and Q4 (15 studies) - regarding accuracy, the highest sensitivity for both general and high-risk populations was achieved using a combination of estimated fetal weight and abdominal circumference tests, where the threshold was defined as either parameter < 10th percentile. No clear trends were observed for the type of reference charts, either for the use of general versus local reference charts (either the estimated fetal weight or birthweight) or for the use of non-sex-specific versus sex-specific birthweight reference charts (nine studies). There is limited evidence linking fetal growth monitoring tests results to the changes in fetal/neonatal outcomes. There is some evidence supporting the reduction of adverse outcomes by Growth Assessment Protocol implementation. Testing during the third trimester is likely to result in more accurate prediction of smallness for gestational age at birth than earlier testing. Use of a locally derived reference chart for estimated fetal weight may result in optimised sensitivity for a given birthweight reference chart (definition of smallness for gestational age). Large diagnostic cohort studies and comparative studies are needed to further examine whether and how fetal growth monitoring testing and implementation of guidance can affect clinical outcomes. This study is registered as PROSPERO CRD42023408030. This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR135862) and is published in full in Health Technology Assessment; Vol. 29, No. 62. See the NIHR Funding and Awards website for further award information.

ECMO in Pregnancy: Analysis of Indications, Management and Outcomes.

Subpartum fetal monitoring is a debated topic in obstetrics. Studies have shown that CTG monitoring can lead to not always necessary interventions such as C-sections and vaginal-operative deliveries. Therefore, the 2021 AWMF S3 guideline "Vaginal Birth at Term" recommends structured intermittent auscultation instead of CTG monitoring in low-risk pregnancies for the first time.In a retrospective cross-sectional study, all German maternity clinics (n=616) were asked using an online questionnaire whether they use intermittent auscultation for low-risk pregnancies as well as reasons for and against it. The response rate was 16% (n=96). RESULTS: 22% (n=21) of clinics reported using intermittent auscultation always or sometimes. A significant correlation was found if changes had occurred and the application of intermittent auscultation (X2=12.95, df=2, p=0.001). Other factors such as the availability of one-to-one care (>95%), midwife-led delivery rooms, and differentiation between high- and low-risk pregnancies had no significant influence on the use of intermittent auscultation.The guideline has not led to the use of intermittent auscultation for monitoring in low-risk pregnancies. Clear low-risk definition, one-to-one care, qualified staff and updated studies on intermittent auscultation vs. CTG are needed.

Understanding and categorizing fetal health is an influential field of research that profoundly impacts the well-being of both mother and child. The primary desire to precisely examine and cure fetal disorders during pregnancy to enhance fetal and maternal outcomes is the driving force behind the classification of fetal health. Fetal cardiac abnormalities (structural or functional) need immediate doctor attention, and their early identification and detection in all stages of pregnancy can help doctors with the timely treatment of the mother and the unborn child by enabling appropriate prenatal counseling and management. By knowing about fetal health and taking necessary precautions for fetal health, the rate of fetal mortality can be decreased. Advancements in machine learning (ML) algorithms have revolutionized the analysis of fetal electrocardiogram (ECG) signals. MachineLearning and Deep Learning algorithms automate the fetal monitoring processanddecisions in emergencies, save time, and enable telemonitoring. This paper introduces a new hybrid approach to enhance fetal health classification using an intelligent and dynamic combination of Random Forest (RF) and AdaBoost machine learning algorithms. The proposed work includes a detailed review of existing models and the challenges in handling fetal health data, setting the foundation for the design of advanced hybrid models. The implemented algorithm effectively integrates the strengths of RF and AdaBoost to enhance fetal health monitoring and classification performance. The RF algorithm is widely established for its capacity to manage large and highly dimensional data sets, whereas AdaBoost focuses on enhancing classification accuracy by correcting for mistakes in the RF models' predictions. The proposed hybrid model is tested on a recognized benchmark CTG dataset, where it attained a classification accuracy of 95.98%, a precision of 92.88%, a recall of 92.78% and an F1 score of 92.70%. Achieved results demonstrate the potential of our novel approach in real-world applications, offering a promising tool for early detection of fetal anomalies, which is crucial for both fetal and maternal health. Fetal health classification and timely prediction of fetal diseases seem to be a critical step throughout pregnancy. So, to deal with this problem, an attempt has been made to propose an accurate, reliable, and novel hybrid approach for enhancing fetal health classification. By combining the strengths of two algorithms, named RF and AdaBoost, superior classification accuracy, precision, F1 score, and recall have been achieved, and much better robustness compared to standalone models. We have strived to make a noteworthy impact on the health sector by developing this hybrid model for the timely evaluation and prediction of fetal-maternal health.

BACKGROUND General anaesthesia during pregnancy requires close monitoring of both mother and foetus and therefore represents a special challenge. Little is known about its impact or its correct management for pregnant women and their foetuses. Therefore, foetoscopic spina bifida repair employing general materno-foetal anaesthesia offers a great opportunity to investigate and further characterise its effects on mother and foetus that would otherwise remain undetermined. OBJECTIVES To evaluate our standard protocol for the anaesthetic management of foetal spina bifida repair with respect to maternal and foetal haemodynamics. DESIGN A retrospective cohort study. SETTING Single-centre study, University Medical Centre Mannheim, University of Heidelberg. PATIENTS We analysed 70 patients in this study. All interventions for foetal spina bifida repair between June 2018 and December 2022 were eligible for this study. MAIN OUTCOME MEASURES During foetoscopic spina bifida surgery, we evaluated materno-foetal haemodynamics and characteristics and safety of our anaesthetic standard protocol. Blood gas analyses (BGAs) and pulse contour cardiac output (PiCCO) analyses were performed regularly. Transabdominal sonography including Doppler analyses of the umbilical artery as a proxy for foetoplacental haemodynamics were performed at predefined time points throughout the procedure. RESULTS During the course of anaesthesia, a significant drop of both median [IQR] maternal base excess and pH were observed: -3.6 [-2.6 to -4.6] vs. -7.1 [-5.3 to -8.25] and 7.35 [7.33 to 7.37] vs. 7.32 [7.29 to 7.35], respectively. PiCCO analyses suggested an increasing need for fluid therapy resulting in a significant increase in the median [IQR] extravascular lung water index, 7 [7 to 8] vs. 8 [7 to 9]. The pulsatility index of the umbilical artery increased during the course of surgery. Despite their significance, these changes did not represent clinically meaningful differences. CONCLUSIONS General materno-foetal anaesthesia could be performed without meaningful effects on materno-foetal haemodynamics and maternal blood gases with the appropriate materno-foetal monitoring in a large number of foetoscopic surgical procedures. There is growing need to enable closer foetal monitoring with respect to depth of anaesthesia, vital signs and pain perception.