Mugyenyi Godfrey R, Atukunda Esther C, Ngonzi Joseph, Boatin Adeline, Wylie Blair J, Haberer Jessica E
Mbarara University of Science and Technology, Mbarara, Uganda.
Mbarara Regional Referral Hospital, Mbarara, Uganda.
BMC Pregnancy Childbirth. 2017 Jun 8;17(1):178. doi: 10.1186/s12884-017-1361-1.
Over 3 million stillbirths occur annually in sub Saharan Africa; most occur intrapartum and are largely preventable. The standard of care for fetal heart rate (FHR) assessment in most sub-Saharan African settings is a Pinard Stethoscope, limiting observation to one person, at one point in time. We aimed to test the functionality and acceptability of a wireless FHR monitor that could allow for expanded monitoring capacity in rural Southwestern Uganda.
In a mixed method prospective study, we enrolled 1) non-laboring healthy term pregnant women to wear the device for 30 min and 2) non-study clinicians to observe its use. The battery-powered prototype uses Doppler technology to measure fetal cardiotocographs (CTG), which are displayed via an android device and wirelessly transmit to cloud storage where they are accessible via a password protected website. Prototype functionality was assessed by the ability to obtain and transmit a 30-min CTG. Three obstetricians independently rated CTGs for readability and agreement between raters was calculated. All participants completed interviews on acceptability.
Fifty pregnant women and 7 clinicians were enrolled. 46 (92.0%) CTGs were successfully recorded and stored. Mean scores for readability were 4.71, 4.71 and 4.83 (out of 5) with high agreement (intra class correlation 0.84; 95% CI 0.74 to 0.91). All pregnant women reported liking or really liking the device, as well as high levels of comfort, flexibility and usefulness of the prototype; all would recommend it to others. Clinicians described the prototype as portable, flexible, easy-to-use and a time saver. Adequate education for clinicians and women also seemed to improve correct usage and minimise concerns on safety of the device.
This prototype wireless FHR monitor functioned well in a low-resource setting and was found to be acceptable and useful to both pregnant women and clinicians. The device also seemed to have potential to improve the experience of the users compared with standard of care and expand monitoring capacity in settings where bulky, wired or traditional equipment are unreliable. Further research needs to investigate the potential impact and cost of such innovations to improve perinatal outcomes.
撒哈拉以南非洲地区每年有超过300万例死产；大多数死产发生在分娩期间，且在很大程度上是可以预防的。在撒哈拉以南非洲的大多数地区，胎儿心率（FHR）评估的护理标准是使用皮纳德听诊器，这限制了在某一时刻只能由一人进行观察。我们旨在测试一种无线FHR监测仪的功能和可接受性，该监测仪可扩大乌干达西南部农村地区的监测能力。
在一项混合方法前瞻性研究中，我们招募了1）未临产的足月健康孕妇佩戴该设备30分钟，以及2）非研究临床医生观察其使用情况。该由电池供电的原型使用多普勒技术测量胎儿心电图（CTG），通过安卓设备显示，并无线传输到云存储，可通过受密码保护的网站访问。通过获取和传输30分钟CTG的能力来评估原型功能。三名产科医生独立对CTG进行可读性评分，并计算评分者之间的一致性。所有参与者都完成了关于可接受性的访谈。
招募了50名孕妇和7名临床医生。成功记录并存储了46份（92.0%）CTG。可读性的平均分数分别为4.71、4.71和4.83（满分5分），一致性较高（组内相关系数为0.84；95%置信区间为0.74至0.91）。所有孕妇都表示喜欢或非常喜欢该设备，以及该原型具有高度的舒适性、灵活性和实用性；所有人都会向他人推荐。临床医生将该原型描述为便于携带、灵活、易于使用且节省时间。对临床医生和孕妇进行充分的教育似乎也能改善正确使用情况，并尽量减少对设备安全性的担忧。
这款原型无线FHR监测仪在资源匮乏的环境中运行良好，被发现对孕妇和临床医生来说都是可接受且有用的。与护理标准相比，该设备似乎还有潜力改善用户体验，并在笨重、有线或传统设备不可靠的环境中扩大监测能力。需要进一步研究调查此类创新对改善围产期结局的潜在影响和成本。
