Harnessing technology to enable all women mobility in labour and birth: feasibility of implementing beltless non-invasive fetal ECG applying the NASSS framework
Abstract:Background
A new wireless and beltless monitoring device utilising fetal and maternal electrocardiography (ECG) and uterine electromyography, known as ‘non-invasive fetal ECG’ (NIFECG) was registered for clinical use in Australia in 2018. The safety and reliability of NIFECG has been demonstrated in controlled settings for short periods during labour. As far as we are aware, at the time our study commenced, this was globally the first trial of such a device in an authentic clinical setting for … Show more
“…18,26 In addition, reported skin irritation from the electrodes does not prevent women from reusing the NI-FECG. 20,27 The aforementioned studies evaluated several NI-FECG devices: Avalon-Beltless, 27 Femom, 4…”
Section: Discussionmentioning
confidence: 99%
“…Previous research has shown that women prefer the comfort of the NI‐FECG device over the DU device 18,26 . In addition, reported skin irritation from the electrodes does not prevent women from reusing the NI‐FECG 20,27 . The aforementioned studies evaluated several NI‐FECG devices: Avalon‐Beltless, 27 Femom, 4 Monica‐AN24, 17,20,21,25,26 Monica‐Novii 18,19 and Nemo 23,24 .…”
IntroductionIn clinical practice, fetal heart rate monitoring is performed intermittently using Doppler ultrasound, typically for 30 minutes. In case of a non‐reassuring heart rate pattern, monitoring is usually prolonged. Noninvasive fetal electrocardiography may be more suitable for prolonged monitoring due to improved patient comfort and signal quality. This study evaluates the performance and patient experience of four noninvasive electrocardiography devices to assess candidate devices for prolonged noninvasive fetal heart rate monitoring.Material and methodsNon‐critically sick women with a singleton pregnancy from 24 weeks of gestation were eligible for inclusion. Fetal heart rate monitoring was performed during standard care with a Doppler ultrasound device (Philips Avalon‐FM30) alone or with this Doppler ultrasound device simultaneously with one of four noninvasive electrocardiography devices (Nemo Fetal Monitoring System, Philips Avalon‐Beltless, Demcon Dipha‐16 and Dräger Infinity‐M300). Performance was evaluated by: success rate, positive percent agreement, bias, 95% limits of agreement, regression line, root mean square error and visual agreement using FIGO guidelines. Patient experience was captured using a self‐made questionnaire.ResultsA total of 10 women were included per device. For fetal heart rate, Nemo performed best (success rate: 99.4%, positive percent agreement: 94.2%, root mean square error 5.1 BPM, bias: 0.5 BPM, 95% limits of agreement: −9.7 – 10.7 BPM, regression line: y = −0.1x + 11.1) and the cardiotocography tracings obtained simultaneously by Nemo and Avalon‐FM30 received the same FIGO classification. Comparable results were found with the Avalon‐Beltless from 36 weeks of gestation, whereas the Dipha‐16 and Infinity‐M300 performed significantly worse. The Avalon‐Beltless, Nemo and Infinity‐M300 closely matched the performance of the Avalon‐FM30 for maternal heart rate, whereas the performance of the Dipha‐16 deviated more. Patient experience scores were higher for the noninvasive electrocardiography devices.ConclusionsBoth Nemo and Avalon‐Beltless are suitable devices for (prolonged) noninvasive fetal heart rate monitoring, taking their intended use into account. But outside its intended use limit of 36 weeks’ gestation, the Avalon‐Beltless performs less well, comparable to the Dipha‐16 and Infinity‐M300, making them currently unsuitable for (prolonged) noninvasive fetal heart rate monitoring. Noninvasive electrocardiography devices appear to be preferred due to greater comfort and mobility.
“…18,26 In addition, reported skin irritation from the electrodes does not prevent women from reusing the NI-FECG. 20,27 The aforementioned studies evaluated several NI-FECG devices: Avalon-Beltless, 27 Femom, 4…”
Section: Discussionmentioning
confidence: 99%
“…Previous research has shown that women prefer the comfort of the NI‐FECG device over the DU device 18,26 . In addition, reported skin irritation from the electrodes does not prevent women from reusing the NI‐FECG 20,27 . The aforementioned studies evaluated several NI‐FECG devices: Avalon‐Beltless, 27 Femom, 4 Monica‐AN24, 17,20,21,25,26 Monica‐Novii 18,19 and Nemo 23,24 .…”
IntroductionIn clinical practice, fetal heart rate monitoring is performed intermittently using Doppler ultrasound, typically for 30 minutes. In case of a non‐reassuring heart rate pattern, monitoring is usually prolonged. Noninvasive fetal electrocardiography may be more suitable for prolonged monitoring due to improved patient comfort and signal quality. This study evaluates the performance and patient experience of four noninvasive electrocardiography devices to assess candidate devices for prolonged noninvasive fetal heart rate monitoring.Material and methodsNon‐critically sick women with a singleton pregnancy from 24 weeks of gestation were eligible for inclusion. Fetal heart rate monitoring was performed during standard care with a Doppler ultrasound device (Philips Avalon‐FM30) alone or with this Doppler ultrasound device simultaneously with one of four noninvasive electrocardiography devices (Nemo Fetal Monitoring System, Philips Avalon‐Beltless, Demcon Dipha‐16 and Dräger Infinity‐M300). Performance was evaluated by: success rate, positive percent agreement, bias, 95% limits of agreement, regression line, root mean square error and visual agreement using FIGO guidelines. Patient experience was captured using a self‐made questionnaire.ResultsA total of 10 women were included per device. For fetal heart rate, Nemo performed best (success rate: 99.4%, positive percent agreement: 94.2%, root mean square error 5.1 BPM, bias: 0.5 BPM, 95% limits of agreement: −9.7 – 10.7 BPM, regression line: y = −0.1x + 11.1) and the cardiotocography tracings obtained simultaneously by Nemo and Avalon‐FM30 received the same FIGO classification. Comparable results were found with the Avalon‐Beltless from 36 weeks of gestation, whereas the Dipha‐16 and Infinity‐M300 performed significantly worse. The Avalon‐Beltless, Nemo and Infinity‐M300 closely matched the performance of the Avalon‐FM30 for maternal heart rate, whereas the performance of the Dipha‐16 deviated more. Patient experience scores were higher for the noninvasive electrocardiography devices.ConclusionsBoth Nemo and Avalon‐Beltless are suitable devices for (prolonged) noninvasive fetal heart rate monitoring, taking their intended use into account. But outside its intended use limit of 36 weeks’ gestation, the Avalon‐Beltless performs less well, comparable to the Dipha‐16 and Infinity‐M300, making them currently unsuitable for (prolonged) noninvasive fetal heart rate monitoring. Noninvasive electrocardiography devices appear to be preferred due to greater comfort and mobility.
“…Existing literature on a similar NIFECG device (Monica AN24, Monica Healthcare, Nottingham, UK) using the same signal acceptance criteria have reported a success rate as low as 49% of the collected traces meeting this criteria 19–21. Moreover, we estimate an additional 30% trace exclusion due to technical issues arising from using a novel device 22. Therefore, we anticipate that we will need to recruit 200 participants to obtain 100 participants with interpretable and informative traces.…”
Section: Methodsmentioning
confidence: 99%
“…[19][20][21] Moreover, we estimate an additional 30% trace exclusion due to technical issues arising from using a novel device. 22 Therefore, we anticipate that we will need to recruit 200 participants to obtain 100 participants with interpretable and informative traces. Open access…”
IntroductionFetal heart rate (FHR) monitoring is a vital aspect of fetal well-being assessment, and the current method of computerised cardiotocography (cCTG) is limited to the hospital setting. Non-invasive fetal ECG (NIFECG) has the ability to produce FHR patterns through R wave detection while eliminating confusion with maternal heart rate, but is presently limited to research use. Femom is a novel wireless NIFECG device that is designed to be placed without professional assistance, while connecting to mobile applications. It has the ability to achieve home FHR monitoring thereby allowing more frequent monitoring, earlier detection of deterioration, while reducing hospital attendances. This study aims to assess the feasibility, reliability, and accuracy of femom (NIFECG) by comparing its outputs to cCTG monitoring.Methods and analysisThis is a single-centred, prospective pilot study, taking place in a tertiary maternity unit. Women with a singleton pregnancy over 28+0weeks’ gestation who require antenatal cCTG monitoring for any clinical indication are eligible for recruitment. Concurrent NIFECG and cCTG monitoring will take place for up to 60 min. NIFECG signals will be postprocessed to produce FHR outputs such as baseline FHR and short-term variation (STV). Signal acceptance criteria is set as <50% of signal loss for the trace duration. Correlation, precision and accuracy studies will be performed to compare the STV and baseline FHR values produced by both devices. The impact of maternal and fetal characteristics on the effectiveness of both devices will be investigated. Other non-invasive electrophysiological assessment parameters will be assessed for its correlation with the STV, ultrasound assessments and maternal and fetal risk factors.Ethics and disseminationApproval has been obtained from South-East Scotland Research Ethics Committee 02 and MHRA. The results of this study will be published in peer-reviewed journals, and presented at international conferences.Trial registration numberNCT04941534.
“…CEFM involves the use of electronic devices to monitor the fetal heart rate and uterine contractions continuously throughout labour [ 1 ]. CEFM may be conducted via a cardiotocograph (CTG) either in wired, or wireless forms, internal scalp electrode (FSE) which involves a spiral electrode being inserted into the fetal scalp or breech [ 2 , 3 ], or non-invasive fetal electrocardiogram (NIFECG), a wireless and beltless monitoring device which has more recently become available on the Australian market [ 4 ]. All forms of CEFM provide real-time information on the fetal heart rate pattern in conjunction with the measurement of uterine activity.…”
Qualitative research about women and birthing people’s experiences of fetal monitoring during labour and birth is scant. Labour and birth is often impacted by wearable or invasive monitoring devices, however, most published research about fetal monitoring is focused on the wellbeing of the fetus. This manuscript is derived from a larger mixed methods study, ‘WOmen’s Experiences of Monitoring Baby (The WOMB Study)’, aiming to increase understanding of the experiences of women and birthing people in Australia, of being monitored; and about the information they received about fetal monitoring devices during pregnancy. We constructed a national cross-sectional survey that was distributed via social media in May and June, 2022. Responses were received from 861 participants. As far as we are aware, this is the first survey of the experiences of women and birthing people of intrapartum fetal monitoring conducted in Australia. This paper comprises the analysis of the free text survey responses, using qualitative and inductive content analysis. Two categories were constructed, Tending to the machine, which explores participants’ perceptions of the way in which clinicians interacted with fetal monitoring technologies; and Impressions of the machine, which explores the direct impact of fetal monitoring devices upon the labour and birth experience of women and birthing people. The findings suggest that some clinicians need to reflect upon the information they provide to women and birthing people about monitoring. For example, freedom of movement is an important aspect of supporting the physiology of labour and managing pain. If freedom of movement is important, the physical restriction created by a wired cardiotocograph is inappropriate. Many participants noticed that clinicians focused their attention primarily on the technology. Prioritising the individual needs of the woman or birthing person is key to providing high quality woman-centred intrapartum care. Women should be provided with adequate information regarding the risks and benefits of different forms of fetal monitoring including how the form of monitoring might impact her labour experience.
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