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| Comprehensive Maternity Care: |
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| Foetal Monitoring System |
| Abstract |
We propose an implantable telemetric system that meets the clinical needs for
accurate foetal ECG monitoring during labour for all pregnancies where monitoring is
indicated, as well as during pregnancy for a selected number of foetuses undergoing foetal
surgery. |
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| Introduction |
As a consequence of recent developments, one can state that the foetus has become a patient,
accessible for diagnosis and therapy. Foetuses may become critically ill during their in utero
life, and may benefit from timely delivery or foetal therapy. Until now, continuous in utero
foetal monitoring has not been possible, since it requires permanent and direct access to the
foetus. Therefore, information from the unborn patient can only be retrieved by indirect and
often inaccurate means (ultrasound, doppler and cardiotocography). If these findings are
suggestive of foetal distress, a foetal blood sample must be taken for confirmation. Foetal
blood sampling is an invasive procedure with its associated risks and offers only momentary
information on the foetal status. The availability of a device that allows for continuous and
accurate monitoring of foetal well-being will reduce the inappropriate preterm delivery or
therapy of foetus, with good foetal well-being and avoid foetal death or brain damage, where
foetal distress has gone unrecognised. |
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| Endoscopy |
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This device will be an indispensable tool for foetus undergoing foetal surgery using a recently
developed technique ofoetoscopy (foetal - endoscopy). The rationale is to take advantage of
the already established access to the foetus during the operation, and at that time to attach
an autonomous monitoring system to it, through an adapted trocart. See Figure 1 for
surgical foetoscopic technique.
The same system can also be used for monitoring during labour for all pregnancies
where foetal monitoring is required. Whereas foetal ECG monitoring is currently
available only non-telemetricly, which implies that the woman is immobilized to the
trocart
recording device during labour, the telemetric intrapartum sensor may be applied on the foetal
scalp like the foetal heart rate electrodes, which are currently used. However, mobilization
during labour will be unrestricted, which benefits the progress of labour and increases the
sense of well-being of the woman.
In the present paper two consecutive approaches are highlighted. The first consists of a simple
telemetric device that continuously transmits the foetal information to the outside world. The
analysis is performed at the receiver site.
The second approach is a novel telemetric unit that will also contain on board circuitry to
record a local analysis. This system will be miniaturised in the future to allow easy and safe
access to the foetus. |
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