FIT4LABOUR– A POTENTIAL FOR ‘SMART’

COMPUTER-BASED TRIAGE AT LABOUR ONSET

M. Tome, L.V. Bozhilova, A. Ugwumadu, L. Impey, A. Georgieva

Oxford Labour Monitoring Group, Nuffield Department of Women’s & Reproductive Health, University of Oxford, UK

OBJECTIVE

Timely identification of fetal compromise at labour onset remains

challenging. We developed Fit4Labour, a digital triage tool that analyses

CTG and clinical risk factors to support clinical decision-making.

 

PRIMARY AIMS:

1. Evaluate accuracy in predicting severe fetal compromise* at birth.

2. Assess impact on clinical decision-making and communication.

*Severe fetal compromise defined as: intrapartum stillbirth, neonatal death, neonatal encephalopathy,

HIE, or seizures.

 

STUDY DESIGN:

1. Retrospective analysis of routinely collected clinical data.

2. Prospective usability and feasibility studies in two UK hospitals.

 

MODEL DEVELOPMENT

Fit4Labour is a prognostic model developed using data from 73,443

monitored term deliveries, including 326 cases of severe compromise

(0.44%) (Figure 1 and 2).

 

The model incorporates the following:

Clinical risk factors

• Maternal age and gestation age

• Temperature in labour

• Preeclampsia status

• Diabetes

• Meconium

 

CTG features at 20 minutes

• Baseline heart rate

• Variability

• Accelerations

• Prolonged deceleration

 

DATA AND RESULTS

(See poster and abstract)

 

POTENTIAL CLINICAL USE

1 in 3 babies

compromised were correctly identified

at 20 minutes.

Predicted Early

6.5-12 hours before birth

Fit4Labour generates early risk predictions with accuracy comparable to clinical

judgement, identifying risk on average 10 hours before delivery (Figures 3 and 4).

In labours scoring below the 50th centile, the tool offers clinician and maternal

reassurance, as the likelihood of severe compromise was significantly reduced.

Usability: Consistently rated highly for ease of use (SUS scores >80) in over 25

clinicians.

Feasibility: Tested in over 90 mothers in early labour, demonstrating reliable, real-

time risk assessment.

 

CONCLUSIONS

Fit4Labour is an innovative digital decision support tool that, at labour onset,

could identify an important proportion of babies who will develop severe

compromise.

Clinical Potential: the tool has the potential to enhance maternity care

through timely, objective risk assessment, supporting clinical decision-

making, improving communication, and facilitating early escalation where

needed.