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<p>Cardiotocography (CTG) is essential for monitoring high-risk pregnancies, yet perinatal asphyxia prediction accuracy remains limited to 50–55%. Regions of artifacts (missing valid signals)-including signal processing aberrations-possibly contribute to this limitation, highlighted by 40% of FDA reports on intrapartum stillbirths. This cohort study applied causal inference to two digitized CTG databases, analyzing 36,792 labor episodes (&gt;36 weeks) at a tertiary Australian hospital (2010–2021) and externally validating on a Czech dataset (<i>n</i> = 552).High rates of missing valid signals (&gt;30% fetal heart rate signal dropout or &gt;1% maternal-fetal heart rate coincidence) was independently associated with asphyxia (aOR 1.47, 95% CI 1.19–1.81); dropout &gt;30% showing stronger link (aOR 1.58, 95% CI 1.13–2.20 Australian dataset; aOR 2.30, 95% CI 1.08–4.91 Czech dataset). Risk of asphyxia increased with higher dropout (&gt;37.45%, aOR 2.21 Australian dataset; &gt;34.01%, aOR 4.08 Czech dataset). Integrating measures of missing valid signals into fetal monitoring algorithms may improve decision-making and neonatal outcomes.</p>

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Impact of missing electronic fetal monitoring signals on perinatal asphyxia: a multicohort analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月1日

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  • Debjyoti Karmakar,
  • Lochana Mendis,
  • Emerson Keenan,
  • Marimuthu Palaniswami,
  • Roxanne Hastie,
  • Enes Makalic,
  • Fiona Brownfoot

摘要

Cardiotocography (CTG) is essential for monitoring high-risk pregnancies, yet perinatal asphyxia prediction accuracy remains limited to 50–55%. Regions of artifacts (missing valid signals)-including signal processing aberrations-possibly contribute to this limitation, highlighted by 40% of FDA reports on intrapartum stillbirths. This cohort study applied causal inference to two digitized CTG databases, analyzing 36,792 labor episodes (>36 weeks) at a tertiary Australian hospital (2010–2021) and externally validating on a Czech dataset (n = 552).High rates of missing valid signals (>30% fetal heart rate signal dropout or >1% maternal-fetal heart rate coincidence) was independently associated with asphyxia (aOR 1.47, 95% CI 1.19–1.81); dropout >30% showing stronger link (aOR 1.58, 95% CI 1.13–2.20 Australian dataset; aOR 2.30, 95% CI 1.08–4.91 Czech dataset). Risk of asphyxia increased with higher dropout (>37.45%, aOR 2.21 Australian dataset; >34.01%, aOR 4.08 Czech dataset). Integrating measures of missing valid signals into fetal monitoring algorithms may improve decision-making and neonatal outcomes.