Researchers at Oxford University have developed a new tool capable of identifying the risk of childbirth complications at the very beginning of labour.
The innovation, named Fit4Labour, aims to provide medical staff with an objective, data-based assessment, potentially allowing for earlier planning and intervention to ensure safer births.
Currently, medical professionals largely rely on cardiotocography (CTG) readings, which monitor a baby's heart rate. However, experts have highlighted that these readings can be open to interpretation and often do not incorporate broader clinical details, such as a mother's gestational age or pre-existing health conditions.
This reliance on CTG alone can mean that some high-risk cases go undetected until later stages of labour, frequently necessitating emergency interventions such as a Caesarean section.
The Fit4Labour tool seeks to address these limitations by integrating the initial 20 minutes of standard CTG tracking with comprehensive clinical data. This combined approach allows it to evaluate the potential threat of severe delivery complications more effectively.
Professor Antoniya Georgieva, a senior author of the study and a researcher at Oxford’s Nuffield Department of Women’s and Reproductive Health, emphasised the tool's potential impact. "Our easy-to-use and reliable risk calculator can support obstetricians and midwives during the early stages of labour by providing an objective data-based assessment of each baby’s risk, helping to reduce variation in clinical assessment," she stated.
Professor Georgieva added: "Fit4Labour is a major improvement on today’s existing processes because it quantifies consistently and objectively, 24/7, what clinicians are already trying to do in their heads when combining clinical risk factors and foetal heart rate data."
The application requires midwives or doctors to input CTG results alongside key maternal information. This includes the mother’s age, gestational stage, whether it is a first child, and any relevant medical conditions such as diabetes or pre-eclampsia.
The findings of the study were published in The Lancet Digital Health. The research encompassed data from over 145,000 births, collected at hospitals in Oxford and Cambridge in the UK, and four hospitals situated in Sweden.
The study specifically included women who were monitored with CTG before the advanced stages of labour and who subsequently delivered their baby within 24 hours of their initial CTG assessment.
Crucially, the study demonstrated that a Fit4Labour risk assessment was, on average, available more than eight hours before birth. This extended timeframe provides medical staff and expectant parents with a significant window to plan for a safer delivery.
Analysis of the data revealed a marked correlation between the tool's risk classifications and actual birth outcomes. Labours identified by Fit4Labour as being in the highest-risk category were found to be between 2.5 and eight times more likely to result in problems for the baby compared to those in the lowest-risk group.
Furthermore, the model proved effective in identifying labours that were more likely to require an emergency Caesarean section, offering critical foresight for clinical teams.
Fit4Labour has already been integrated into the care of 90 women across two hospitals as part of ongoing research initiatives.
Mariana Tome, a research fellow in the department, highlighted the challenge of current methods. "We have all been in the room when a CTG is ambiguous and everyone’s interpretation differs," she commented. "Having an objective, reproducible risk estimate at labour onset could make a real difference to how we triage, communicate, and make decisions with families."
Oxford University has confirmed that a dedicated spinout company, Safer Birth, is now collaborating with the NHS to facilitate the wider implementation and use of the Fit4Labour tool across healthcare settings.
