Fetosense and U- Act: Novel Solutions for Monitoring Fetal Heart Rate and Uterine Activity to Reduce Neonatal Morbidity and Mortality

Abstract

About 0.75 million neonates die annually in India, and preterm birth contributes to 43 percent of neonatal deaths. Simple, accurate, and timeand cost-efficient labor-monitoring tools are scarce at the grassroots level, particularly for the estimated 150,000 subcenters manned by the auxiliary nurse midwives. The current standard, cardiotocography, has poor accuracy and is bulky, difficult to use, expensive, sensitive to maternal obesity and movements, and not scalable. CareNX Innovations has developed two interconnected, indigenous, and portable smartphone-enabled solutions: Fetosense, for fetal heart monitoring, and U-Act, for monitoring of uterine contractions for early identification of and intervention for preterm labor. When used with our existing mobile maternal care program, CareMother, which involves doorstep antenatal tests conducted by frontline workers using a portable diagnostic kit, cloud-based data sharing, and a mobile application, both Fetosense and U-Act can provide an end-to-end solution for effective labor monitoring to reduce postnatal complications. India reports 26 million viable pregnancies annually. Of those 50-60 percent are estimated as high risk, served by an estimated 135,000 hospitals and more than 300,000 clinics. However, India has only 35,000 gynecologists, so greater use of Fetosense and U-Act at these facilities would be beneficial. Results can be auto-interpreted using machine-learning algorithms, to correlate recurrent patterns in fetal heart rate and uterine activity with fetal cardiac function, metabolic acidosis, and neonatal outcomes. This will reduce the continuous dependence on the clinician and enable substantially greater use of remote monitoring by doctors. Problem and Context Monitoring a woman’s labor is essential to track its progress, assess fetal heart rate, and measure uterine contractions to identify any excessive activity that may lead to adverse fetal outcomes (Ayres‐de‐Campos, Spong, and Chandraharan 2015; Bakker and van Geijn 2008; Reuwer, Bruinse, and Franx 2009), which are linked to neonatal mortality and morbidity. About 0.75 million neonates die annually in India, more than anywhere else in the world. The decline in the neonatal mortality rate (NMR), from 52 per 1,000 live births in 1990 to 28 per 1,000 live births in 2013, has been slower than the reduction in mortality rates among infants and under-5 children (Sankar and others 2016). Figure 1 shows the variable distribution of neonatal mortality across the states of India.