From protocol to practice: advancing monitoring in high risk pregnancies
Nadine de Klerk defended her PhD thesis at the Department of Electrical Engineering on 7 September.
Pregnancy is usually a healthy and natural process, but for some women it involves serious risks for both mother and baby. These so-called high-risk pregnancies require close monitoring to detect problems at an early stage. However, current monitoring methods are not always reliable or continuous, meaning that important warning signs may be missed. In her PhD research, Nadine de Klerk explores how new technologies and innovative research methods can improve monitoring in high-risk pregnancies and ultimately contribute to better outcomes.
In clinical practice, fetal wellbeing is commonly assessed using cardiotocography (CTG), a method that measures the baby鈥檚 heart rate, the mother鈥檚 heart rate and uterine contractions. Although widely used, CTG has important limitations. It is typically performed only once to three times a day for around 30 minutes. As a result, it provides only limited insight into fetal wellbeing between measurements. In addition, it can be affected by signal loss and variability in interpretation. These challenges are particularly relevant in preterm or complicated pregnancies, where deterioration can occur rapidly and unexpectedly.
Electrophysiological cardiotocography
鈥檚 research focuses on a promising new technique to address these limitations: electrophysiological cardiotocography (eCTG). With this technique the electrical activity of the fetal heart is measured through electrodes placed on the mother鈥檚 abdomen. This allows for continuous, wireless monitoring, with expected improvements in signal quality and greater comfort for the patient. Continuous monitoring may provide more detailed information about fetal wellbeing over time and could support earlier detection of complications.
The NIEM-O study
The central part of this research consists of the NIEM-O study, which was conducted at M谩xima MC, a tertiary obstetric care center in the Netherlands. This study investigates whether continuous eCTG monitoring improves outcomes in women admitted with high-risk pregnancies. Early findings suggest that continuous monitoring is feasible and can be applied safely in clinical practice. However, these results should be interpreted with caution. The interim analysis is based on a relatively small sample size, and technical challenges such as signal loss were encountered. Therefore, any observed trends or potential benefits are preliminary and should not yet be considered conclusive. The NIEM-O study is currently ongoing, and final conclusions about clinical effectiveness can only be drawn after completion of the full study.
The Cohort Intervention Random Sampling Study
In addition to evaluating new monitoring technology, this research introduces an innovative research design: the Cohort Intervention Random Sampling Study (CIRSS). Traditional randomized trials can be difficult or ethically challenging in high-risk pregnancy care. CIRSS offers a more flexible alternative that combines elements of clinical trials and observational studies, enabling the evaluation of new interventions within real-world clinical practice while maintaining scientific rigor.
A broader view of monitoring high-risk pregnancies
De Klerk also addresses several broader aspects of monitoring high-risk pregnancies in her research. One study shows that commonly used interpretation guidelines for fetal monitoring are not fully applicable to extremely preterm infants, emphasizing the need for gestational age-specific approaches. Another study demonstrates that environmental factors such as season and climate can influence the risk of preterm birth, suggesting new opportunities for prevention. Furthermore, a review of home-based monitoring indicates that, under the right conditions, monitoring outside the hospital appears to be safe, which could improve patient comfort and reduce the burden on healthcare services.
Perspectives of healthcare professionals
Finally, the perspectives of healthcare professionals were explored. These professionals are generally open to continuous monitoring and recognize its potential benefits, but they also highlight important challenges. These include technical limitations, the need for reliable signal quality, and the importance of training and integration into routine care.
In conclusion, continuous fetal monitoring using new technologies such as eCTG shows promise for improving care in high-risk pregnancies. This research demonstrates that innovation in both technology and study design can contribute to more personalized and effective monitoring, while also highlighting the importance of careful evaluation, clinical feasibility, and implementation in practice.
Titel of PhD thesis: . Supervisors: Prof. Guid Oei, Prof. Judith van Laar and Dr. Annemarie Fransen (Zuyderland Medisch Centrum).