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Birth asphyxia: diagnosing fetal distress during labour

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What did the project achieve?

“We have developed the first prototype for a new computer-based diagnostic system that could help doctors identify babies who are at risk of oxygen deprivation during birth,” says researcher and scientific director at the University of Oxford, Dr Antoniya Georgieva. “With further refinement and testing, we hope one day it will help save lives by preventing birth complications – and also reduce unnecessary emergency interventions.”

Every year, it’s estimated that more than 1,200 babies in the UK are starved of oxygen with a reduced blood supply to their brain during labour at term.1,2,3 Sadly, birth asphyxia can have terrible consequences, with many babies losing their lives or being left with long-term complications, like cerebral palsy.

During labours classed as ‘high-risk’, doctors and midwives continuously monitor the baby’s heartbeat to spot any sign of distress early. But the patterns are complex and difficult to interpret – so Dr Georgieva and her team are developing a new computer-based diagnostic system to help.

“We have now carried out sophisticated computer-based analyses of the heart traces from nearly 60,000 babies, the largest database of its kind in the world,” says Dr Georgieva. “By combining these data with other clinical risk factors, we have now designed and tested several prototype diagnostic systems.”

The team has shown that their most up-to-date version performs favourably compared to clinical assessment by a doctor or midwife. They have also started to search for other clues that could help make it even more accurate, such as biological markers in the mother’s blood.

“We are confident that we can continue to improve our new system and, as a result of the Action funded grant, Dr Georgieva has secured a generous personal fellowship from the National Institute of Health Research to expand this work. We will aim to take the new diagnostic system into a clinical trial in the future,” she says.


1. Perinatal Mortality 2008, Centre for Maternal and Child Enquiries, United Kingdom, London (2010).

2. J.J. Kurinczuk, M. White-Koning, N. Badawi. Epidemiology of neonatal encephalopathy and hypoxicischaemic encephalopathy Early Hum Dev 86, 329-38 (2010).

3. Office for National Statistics. Vital Statistics: Population and Health Reference Tables. Website accessed 12 July 2018.

This research was completed on

Oxygen deprivation during birth: identifying babies at risk

Midwives and doctors often monitor babies’ heartbeats during childbirth to find out how they are coping and check they are getting enough oxygen. The equipment they use, which was introduced nearly 50 years ago, produces a chart that can be difficult to interpret. Sometimes it is hard to tell how a baby is doing, and whether they should be delivered urgently by emergency caesarean section. Professor Christopher Redman, from the University of Oxford, is investigating whether computerised interpretation of charts could help.

What is the problem and who does it affect?

Worldwide, nearly one quarter of babies who die within a month of birth lose their lives to a problem called birth asphyxia – oxygen deprivation and a reduced blood supply to the brain around the time of birth that lasts long enough to be harmful.1,2 Babies who are short of oxygen during childbirth are in immediate danger, and must be delivered urgently, by an emergency caesarean section, for example.

The first clue that a baby is in trouble during childbirth often comes from abnormalities in the baby’s heartbeat. “Sometimes it is difficult to interpret changes in a baby’s heartbeat, which leads to uncertainty over whether a baby actually has birth asphyxia,” explains Professor Redman. “In this situation, doctors often make a fail-safe decision to intervene, and deliver the baby by caesarean section, thinking it is better to be safe than sorry. Often though, it turns out that the baby was actually fine and the caesarean – a major operation for the mother – was unnecessary.”

Sadly, in some other cases, babies’ problems are not spotted soon enough. “Birth asphyxia kills 250 babies each year in the UK and babies who survive can be left with life-long disabilities such as cerebral palsy,” explains Professor Redman.3

What is the project trying to achieve?

The equipment used during labour to check how well a baby is coping produces a paper chart displaying two lines – one showing the baby’s heartbeat and another showing the mother’s contractions. “The equipment generates yards of paper,” explains Professor Redman. “The pattern it displays of the baby’s heartbeat can be complex. Doctors and midwives have to assess this pattern by eye, which can be very difficult. Even experts can disagree about whether or not the chart suggests the baby is in trouble.”

“We are investigating whether computers can do a better job of interpreting the baby’s heartbeat, deciding whether the baby has birth asphyxia and recommending whether an urgent delivery by caesarean section is necessary,” continues Professor Redman. “Improving this decision-making process could stop healthy babies from being born by unnecessary caesareans and protect babies who do have birth asphyxia from death and disability.” The team is using data collected on nearly 30,000 births.

What are the researchers’ credentials?


Professor Redman has been researching ways to monitor the health of babies within the womb for over 30 years. He has already successfully developed a computerised system that interprets the heartbeats of babies during pregnancy, before labour begins. This system, the first of its kind, has been used worldwide for more than 20 years.


  1. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where Why? Lancet 2005; 365(9462); 891-900.
  2. Bryce J, et al. WHO estimates of the causes of death in children. Lancet 2005; 365:1147-52.
  3. CMACE, Perinatal mortality 2008, London 2010.


Project Leader Professor S Kennedy
Project Team Dr S J PayneDr A E GeorgievaMr A Papageorghiou Professor C W G Redman
Project Location Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital and Institute of Biomedical Engineering, University of Oxford
Project Location Other Fetal Medicine Unit, St Georges Hospital, London
Project duration 36 months
Date awarded 10 November 2011
Project start date 1 May 2012
Project end date 29 February 2016
Grant amount £133,262
Grant code GN1946
Acknowledgements This project supported by a generous grant from The Henry Smith Charity.


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