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Preventing stillbirth from obstructed labor: A sensorized, low-cost device to train in safer operative birth

Jaufuraully, Shireen; Salvadores Fernandez, Carmen; Bagchi, Biswajoy; Gupta, Priya; Desjardins, Adrien; Siassakos, Dimitrios; David, Anna L; (2023) Preventing stillbirth from obstructed labor: A sensorized, low-cost device to train in safer operative birth. Frontiers in Global Women's Health , 3 , Article 1039477. 10.3389/fgwh.2022.1039477. Green open access

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Abstract

BACKGROUND: 98% of stillbirths occur in low- and middle- income countries. Obstructed labor is a common cause for both neonatal and maternal mortality, with a lack of skilled birth attendants one of the main reasons for the reduction in operative vaginal birth, especially in low- and middle- income countries. We introduce a low cost, sensorized, wearable device for digital vaginal examination to facilitate accurate assessment of fetal position and force applied to the fetal head, to aid training in safe operative vaginal birth. METHODS: The device consists of flexible pressure/force sensors mounted onto the fingertips of a surgical glove. Phantoms of the neonatal head were developed to replicate sutures. An Obstetrician tested the device on the phantoms by performing a mock vaginal examination at full dilatation. Data was recorded and signals interpreted. Software was developed so that the glove can be used with a simple smartphone app. A patient and public involvement panel was consulted on the glove design and functionality. RESULTS: The sensors achieved a 20 Newton force range and a 0.1 Newton sensitivity, leading to 100% accuracy in detecting fetal sutures, including when different degrees of molding or caput were present. They also detected sutures and force applied with a second sterile surgical glove on top. The software developed allowed a force threshold to be set, alerting the clinician when excessive force is applied. Patient and public involvement panels welcomed the device with great enthusiasm. Feedback indicated that women would accept, and prefer, clinicians to use the device if it could improve safety and reduce the number of vaginal examinations required. CONCLUSION: Under phantom conditions to simulate the fetal head in labor, the novel sensorized glove can accurately determine fetal sutures and provide real-time force readings, to support safer clinical training and practice in operative birth. The glove is low cost (approximately 1 USD). Software is being developed so fetal position and force readings can be displayed on a mobile phone. Although substantial steps in clinical translation are required, the glove has the potential to support efforts to reduce the number of stillbirths and maternal deaths secondary to obstructed labor in low- and -middle income countries.

Type: Article
Title: Preventing stillbirth from obstructed labor: A sensorized, low-cost device to train in safer operative birth
Location: Switzerland
Open access status: An open access version is available from UCL Discovery
DOI: 10.3389/fgwh.2022.1039477
Publisher version: https://doi.org/10.3389/fgwh.2022.1039477
Language: English
Additional information: © 2023 Jaufuraully, Salvadores Fernandez, Bagchi, Gupta, Desjardins, Siassakos, David and Tiwari. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Keywords: cesarean section, obstructed labor, operative vaginal birth, sensorized glove, stillbirth
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Maternal and Fetal Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10165675
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