At-Home Fetal Health Monitoring Using Smartphones
Overview
The goal of this research is to build an easy-to-use system for ubiquitous at-home monitoring of fetal health by pregnant women themselves. Unfortunately, 21,000 families lose their fetuses each year according to a recent CDC report. Frequent fetal heart rate monitoring is one important method for preventing fetal mortality. Current barriers to prenatal care include physician shortages, remote geography, and high patient burden due to the need for multiple antenatal visits. This raises a need to develop novel tools that enable frequent, remote, and self-administered fetal monitoring. My study aims to bridge the gap in accessibility of the expensive medical grade tools available for self-administration of fetal health along with promoting more frequent monitoring of fetal health as compared to limited antenatal clinic visits. The proposed system includes converting the smartphone into an active sonar system and using the Doppler effect to predict the fetal heartbeat readings. In addition to developing the technology, We aim to run a qualitative study to better inform the interaction between the smartphone application and the user. The project envisions having an impact on pregnant women globally who have access to smartphones. With over 6.9 billion smartphones in existence, our smartphone-based non-invasive solution aims to provide inclusivity in terms of geography, in addition to being an affordable alternative due to minimum/no extra hardware costs hence improving accessibility. Figure below presents an overview of the research methodology.
Relevant Literature
Fetal morbidity and mortality[1] are major but often overlooked public health issues. Much of the public concern surrounding reproductive loss has focused on infant mortality, due in part to a paucity of knowledge of the incidence, etiology, and prevention strategies for fetal mortality. The causes and rates of fetal morbidity and mortality differ extensively across developed and less-developed countries. Since 2000, good progress has been made in reducing the stillbirth rate globally, which declined from 21.4 stillbirths per 1,000 total births in 2000 to 13.9 in 2019 – a 35% reduction.[2] However, compared to the annual rates of reduction for other mortality indicators, the gains made in reducing stillbirths have been much slower, with progress lagging behind across all regions since 2000. Globally, there are approximately 2 million stillbirths every year with over 40% occurring after the onset of labor, the majority of which could be prevented with better quality and respectful care during childbirth. In 2014, the World Health Assembly endorsed the Every Newborn Action Plan (ENAP) which includes a global target of 12 or fewer stillbirths per 1000 total births in every country by 2030. A 2020 report from the United Nations Interagency Group for Child Mortality Estimation, estimated that 56 countries are at risk of missing the 2030 target (the majority located in sub-Saharan Africa and South Asia)[3]. Over the next decade, 20 million babies are projected to be stillborn, 2.9 million of which could be prevented by accelerating progress to meet the ENAP target in these 56 at risk countries. Most of these antepartum fetal surveillance techniques are based on analyzing the fetal heart rate patterns and fetal movements. The United States witnesses more than 55% of the perinatal mortality [4] which could be prevented with efficient fetal monitoring and testing.
The medical gold standard for external fetal monitoring is cardiotocography (CTG) [5]. CTG is the visual representation of fetal heart rate (FHR) and uterine contractions. However, since CTG can only be applied by the medical professionals in a clinical setting hence, it lacks portability and results in only episodic monitoring of fetuses' health [6]. Prior studies focused on developing handheld ultrasound devices which project the visual results on the person’s mobile phone hence creating portable phone ultrasound devices [7]. But, still such ultrasound devices need some level of expertise/training to determine the position of the fetus in the womb of the pregnant subject. Other studies have developed non-invasive wearable belts [8-10] , abdominal patches [10,11] embedded with sensors such as ECG, EMG, acoustic, ultrasonic ceramic transducers, pressure sensors etc, to measure different fetal health parameters. However, some of the major limitations for such research include not investigating the study in a real-world setting, comfort issues due to having to wear an external device on the stomach by the pregnant women, limited usability to women in the last trimester of pregnancy, etc. Lately, there has been an increase in transforming mobile phones into health monitoring devices [13-15]. We propose the use of mobile phones and their in-built sensors to non-invasively record and present fetal heart rate and fetal movement data. The use of smartphones provide various benefits including the easy-to-do fetal health monitoring by individuals, greater uptake of home fetal health monitoring due to the inherent portability of the mobile phones. Also, the low-cost of mobile phones as compared to other at-home monitoring devices can help increase accessibility to a wider population. Mobile phones also present the capability of easy recording, saving and longitudinal tracking of the results and hence present a comprehensive fetal monitoring for the pregnant women.