Saving babies and families from preventable harm: a review of the current state of fetoplacental monitoring and emerging opportunities

Neonatal outcomes have improved over the last decade following significant thrust in this area, but stillbirth, preterm birth and neonatal brain injury remain acute global problems with long-lasting parental and family psychological trauma. In 2020, 1 in every 225 pregnancies in UK ended in stillbirth, with 2 million stillbirths reported worldwide. Over 40% of all stillbirths occur during labor—a loss that could be avoided with improved fetal monitoring and timely access to emergency obstetric care when required. Nearly one-fourth of global neonatal mortality relates to intrapartum-related events. Currently, available monitoring tools rely on surrogate markers such as serial fetal size measurement, doppler assessment of fetoplacental perfusion, fetal heart rate variability, fetal movements and maternal circulating placental proteins to identify the vulnerable fetus. Continuous cardiotocography (CTG) is the current standard of monitoring for fetal assessment in labor, but a Cochrane review indicated that it failed to significantly reduce poor outcomes in newborn infants, and resulted in an increase in the number of Caesarean sections. There is an urgent need for the development of a monitoring platform to directly measure acute or chronic changes related to fetoplacental compromise which can be operated with ease both in the hospital and remotely in the home environment in high-risk pregnancies. In recent years, there has been some promising development to identify compromised fetuses using advanced technologies and artificial intelligence-based approaches. We present here the current state of fetoplacental monitoring, focussing primarily on antepartum monitoring and discuss a possible way forward using digital biomarkers in this area to protect babies and mothers in future.