Methods for Monitoring Risk of Hypoxic Damage in Fetal and Neonatal Brains: A Review

Fetal, perinatal, and neonatal asphyxia are vital health issues for the most vulnerable groups in human beings, including fetuses, newborns, and infants. Severe reduction in oxygen and blood supply to the fetal brain can cause hypoxic-ischemic encephalopathy, leading to long-term neurological disorders, including mental impairment and cerebral palsy. Such neurological disorders are major healthcare concerns. Therefore, there has been a continuous effort to develop clinically useful diagnostic tools for accurately and quantitatively measuring and monitoring blood and oxygen supply to the fetal and neonatal brain to avoid severe consequences of asphyxia Hypoxic-Ischemic Encephalopathy (HIE) and Neonatal Encephalopathy (NE). Major diagnostic technologies used for this purpose include fetal heart rate monitoring (FHRM), fetus scalp blood sampling (FBS), ultrasound (US) imaging, magnetic resonance imaging (MRI), x-ray computed tomography (CT), and nuclear medicine. In addition, given the limitations and shortcomings of traditional diagnostic methods, emerging technologies such as near-infrared spectroscopy (NIRS) and photoacoustic (PA) imaging have also been introduced as stand-alone or complementary solutions to address this critical gap in fetal and neonatal care. This review provides a thorough overview of the traditional and emerging technologies for monitoring fetal and neonatal brain oxygenation status and describes their clinical utility, performance, advantages, and disadvantages.

Challenges of Developing Robust AI for Intrapartum Fetal Heart Rate Monitoring

Background: CTG remains the only non-invasive tool available to the maternity team for continuous monitoring of fetal well-being during labour. Despite widespread use and investment in staff training, difficulty with CTG interpretation continues to be identified as a problem in cases of fetal hypoxia, which often results in permanent brain injury. Given the recent advances in AI, it is hoped that its application to CTG will offer a better, less subjective and more reliable method of CTG interpretation.Objectives: This mini-review examines the literature and discusses the impediments to the success of AI application to CTG thus far. Prior randomised control trials (RCTs) of CTG decision support systems are reviewed from technical and clinical perspectives. A selection of novel engineering approaches, not yet validated in RCTs, are also reviewed. The review presents the key challenges that need to be addressed in order to develop a robust AI tool to identify fetal distress in a timely manner so that appropriate intervention can be made.Results: The decision support systems used in three RCTs were reviewed, summarising the algorithms, the outcomes of the trials and the limitations. Preliminary work suggests that the inclusion of clinical data can improve the performance of AI-assisted CTG. Combined with newer approaches to the classification of traces, this offers promise for rewarding future development.

FETOMATERNAL OUTCOME IN MECONIUM STAINED AMNIOTIC FLUID IN A TERTIARY RURAL HEALTH CARE CENTRE

Background: The study was undertaken to determine the correlation of amniotic uid stained with meconium (MSAF) with maternal and fetal outcome. Methods: This prospective observational study was carried out in the Department of Obstetrics and gynecology, Sri Adichunchanagiri Institute of Medical Sciences, BG Nagara for over a period of 6 months between July 2020 and December 2020. A total of 168 pregnant women were included in the study. MSAF on spontaneous or articial rupture of membranes were monitored during labour with fetal heart rate abnormality, consistency of liquor, 1 minute and 5 minute Apgar score, LSCS, instrumental delivery, NICU admissions and neonatal complications as outcome variables. Results: Women were divided into two groups: 69 were cases with meconium stained amniotic uid (MSAF) and 99 were controls with clear amniotic uid. Among 69 cases with MSAF 17.4% were unbooked & 82.6% were booked (at least 3 visits in rst trimester), 79.7% were between 20-30 years of age group. Primigravida's constituted 55.1% in the study group. Approximately 34.8% had gestational ages of >39- 40 weeks. Caesarean section done in cases of MSAF accounted for 55.1% Normal deliveries were 36.2% in cases and 45.5% in controls. Conclusions: Presence of MSAF is worrisome for both the obstetrician and pediatricians view as it increases surgical intervention, birth asphyxia, MAS & NICU admissions. Continuos fetal heart rate monitoring during labour and reassurance of fetal well-being by acid-base assessment were most signicant factors in the reduction of meconium aspiration syndrome