INFANT
Athena
Maternity Information System
K2MS Portal -
Medical Grade Touchscreen PC
K2MS Guardian
V2 - Full electronic capture of patient information during childbirth
K2MS Online Fetal
Monitoring Training System
K2MS Expert Datacare - Cord Blood Gas
Analysis
Background
Childbirth is a stressful time for all involved; the mother, partner, clinicians and most of all for the unborn child who is at risk of suffering oxygen deprivation that can lead to brain damage or death. All babies have their heart rates routinely monitored during childbirth to attempt to detect when they might be in trouble whereupon they can be rescued by Caesarean section or forceps. In low risk mothers this can be done by listening periodically to the baby’s heart beat using stethoscope type device. If the labour is regarded as being high risk then continuous electronic fetal monitoring (EFM) is performed. Sensors are held in place on the maternal abdomen and are used to record the infant’s heart rate and mother’s contractions. These are printed as a continuous plot called the cardiotocogram (CTG), figure 1. A clinician will infer the condition of the fetus from a visual interpretation of its heart rate changes in response to contractions, the times of maximum stress. Approximately 70% of women are monitored continuously using EFM.
Fig 1. Click to enlarge
Figure 1. The Cardiotocogram
This plot represents approximately 40 minutes of recording and shows the fetal heart rate on the upper scale and the mother’s contractions on the lower scale. The fetal heart rate is normally approximately 140 beats per minute and contractions occur approximately 4 times in 10 minutes.
Continuous monitoring was introduced in the early 1970s to attempt to reliably detect when fetal stress became fetal distress whereupon the infant could be rescued by clinical intervention. It was hoped to make fetal asphyxia, brain damage and death during childbirth a thing of the past. Unfortunately, this has not proved to be the case.
There was a growing suspicion in the 1980s, that has since been verified in national independent investigations (Confidential Enquiry into Stillbirths and Deaths in Infancy, CESDI now known as CEMACH www.cemach.org.uk, see references) , that babies died or were brain damaged as a result of mis-interpretation of the CTG by clinicians. In particular it was found that 75% of all stillbirths that occur during labour die as a result of human error. These infants are the tip of the iceberg. Many more suffer irreversible brain damage. The financial cost to the NHS for this negligence is immense and continues to grow exponentially. Today the total liability against the NHS for all medical litigation stands at over £4billiion of which obstetrics accounts for at least 60% of this value.
Mis-interpretation of patient monitoring during childbirth continues to be a major problem that is very much in the public domain in all first world countries around the world. Interpretation of the CTG is difficult. The expertise required does not reside with all clinicians and is not available at all times of the day and night.
INFANT
Our response to these problems was to develop computer software called INFANT. INFANT is an analysis engine that can identify the same types of features in the CTG as experts and can raise concern accordingly. Effectively, INFANT is a warning system that alerts clinicians to possible deteriorations in fetal wellbeing based on an automated interpretation of the fetal heart rate and contractions pattern. It is not intended to replace human interpretation but to support it.
Click to enlarge
INFANT software is deployed as a module within K2MS Guardian, an obstetric risk management system that compiles a full electronic patient record for labour and delivery at the patient’s bedside and communicates this in real time across the hospital computer network including Consultant’s homes. Guardian has been sold to 20+ hospitals in UK, Ireland and Australia and is an approved class IIa medical device.
INFANT Trial
Our response to these problems was to develop computer software called INFANT. INFANT is an analysis engine that can identify the same types of features in the CTG as experts and can raise concern accordingly. Effectively, INFANT is a warning system that alerts clinicians to possible deteriorations in fetal wellbeing based on an automated interpretation of the fetal heart rate and contractions pattern. It is not intended to replace human interpretation but to support it.
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