Does fetal heart rate count? Developing a low cost, alternative powered doppler fetal heart monitor for use in low resource high mortality settings

Background: Intrapartum events kill 1 million babies and over 1 million stillbirths globally each year and contribute to over half of all maternal deaths. Effective intrapartum monitoring could save many of these lives and also reduce morbidity in survivors. Intermittent fetal heart auscultation is as safe as continuous electronic monitoring in low risk labours. Doppler ultrasound fetal heart monitor is regarded as the most promising fetal monitoring device in low resource settings, but its use is limited by the cost, the availability of existing devices and the lack of alternative power supply options. Aims: To develop a Doppler fetal heart monitor which is accurate and reliable but has alternative options for power supply (wind-up, electric, solar), is robust and is affordable for use in the settings where most women and children die. To compare the reliability of the prototype with a cardiotocograph, assess if the prototype is appropriate for use in low resource settings and if it is acceptable to health workers and patients. Methods: Five prototypes have been designed and are being assessed for accuracy, acceptability, and usability in small field trials in South Africa. Results: 661 fetal heart rate readings in labour were measured on 17 mothers with the prototype and a cardiotocograph. Statistical analysis showed no significant difference between the readings from the prototype compared to the cardiotocograph. The correlation coefficient was 94%. The prototype readings remain accurate as the power supply runs low. Winding for 20 seconds results in an average of 2 min 31 seconds of continuous use. In a survey of 97 mothers 72 (74%) preferred the prototype to a cardiotocograph or fetoscope. Conclusion: Initial field testing shows this novel device to be accurate and acceptable to both mother and health workers in