Functionality and acceptability of a wireless fetal heart rate monitoring device in term pregnant women in rural Southwestern Uganda
Functionality and acceptability of a wireless fetal heart rate monitoring device in term pregnant women in rural Southwestern Uganda
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DOI：
10.1186/s12884-017-1361-1
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发表时间：
2017-06-08
影响因子：
3.1
通讯作者：
Haberer, Jessica E.
中科院分区：
文献类型：
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作者：
Mugyenyi, Godfrey R.;Atukunda, Esther C.;Haberer, Jessica E.
背景：撒哈拉以南非洲地区每年发生超过 300 万死产；大多数发生在产时，并且在很大程度上是可以预防的。在大多数撒哈拉以南非洲地区，胎儿心率 (FHR) 评估的护理标准是皮纳德听诊器，限制了在某个时间点只能对一个人进行观察。我们的目的是测试无线胎心率监测器的功能和可接受性，以扩大乌干达西南部农村地区的监测能力。方法：在一项混合方法前瞻性研究中，我们招募了 1）非临产健康足月孕妇佩戴该设备 30 分钟，2）非研究临床医生观察其使用情况。该电池供电的原型使用多普勒技术来测量胎儿胎心宫缩图 (CTG)，这些结果通过 Android 设备显示，并无线传输到云存储，可通过受密码保护的网站访问。原型功能通过获取和传输 30 分钟 CTG 的能力进行评估。三位产科医生独立评估 CTG 的可读性，并计算评估者之间的一致性。所有参与者均完成了可接受性访谈。结果：纳入了 50 名孕妇和 7 名临床医生。 46 (92.0%) CTG 被成功记录和存储。可读性的平均得分为 4.71、4.71 和 4.83（满分 5 分），一致性很高（组内相关性 0. 84；95% CI 0.74 至 0.91）。所有孕妇都表示喜欢或非常喜欢该设备，以及原型的高度舒适性、灵活性和实用性；所有人都会向其他人推荐它。临床医生将该原型描述为便携、灵活、易于使用且节省时间。对临床医生和女性进行充分的教育似乎也可以提高正确使用方法并最大限度地减少对设备安全性的担忧。结论：这款无线胎心率监测仪原型在资源匮乏的环境中运行良好，并且被发现对孕妇和临床医生来说都是可以接受和有用的。与护理标准相比，该设备似乎还有潜力改善用户的体验，并在笨重、有线或传统设备不可靠的环境中扩大监控能力。需要进一步的研究来调查此类创新对改善围产期结局的潜在影响和成本。
Background: Over 3 million stillbirths occur annually in sub Saharan Africa; most occur intrapartum and are largely preventable. The standard of care for fetal heart rate (FHR) assessment in most sub-Saharan African settings is a Pinard Stethoscope, limiting observation to one person, at one point in time. We aimed to test the functionality and acceptability of a wireless FHR monitor that could allow for expanded monitoring capacity in rural Southwestern Uganda.Methods: In a mixed method prospective study, we enrolled 1) non-laboring healthy term pregnant women to wear the device for 30 min and 2) non-study clinicians to observe its use. The battery-powered prototype uses Doppler technology to measure fetal cardiotocographs (CTG), which are displayed via an android device and wirelessly transmit to cloud storage where they are accessible via a password protected website. Prototype functionality was assessed by the ability to obtain and transmit a 30-min CTG. Three obstetricians independently rated CTGs for readability and agreement between raters was calculated. All participants completed interviews on acceptability.Results: Fifty pregnant women and 7 clinicians were enrolled. 46 (92.0%) CTGs were successfully recorded and stored. Mean scores for readability were 4.71, 4.71 and 4.83 (out of 5) with high agreement (intra class correlation 0. 84; 95% CI 0.74 to 0.91). All pregnant women reported liking or really liking the device, as well as high levels of comfort, flexibility and usefulness of the prototype; all would recommend it to others. Clinicians described the prototype as portable, flexible, easy-to-use and a time saver. Adequate education for clinicians and women also seemed to improve correct usage and minimise concerns on safety of the device.Conclusions: This prototype wireless FHR monitor functioned well in a low-resource setting and was found to be acceptable and useful to both pregnant women and clinicians. The device also seemed to have potential to improve the experience of the users compared with standard of care and expand monitoring capacity in settings where bulky, wired or traditional equipment are unreliable. Further research needs to investigate the potential impact and cost of such innovations to improve perinatal outcomes.