Globally, approximately 99 per cent of neonatal deaths occur in low- and middle-income countries (LMICs). It is precisely in these countries that access to adequate foetal monitoring is often limited. In Tanzania, where neonatal mortality stands at 24 per 1,000 live births, a new wireless technology for foetal heart rate monitoring shows that digital healthcare can save lives even in resource-poor settings.
Researchers from Hiroshima University and Muhimbili University of Health and Allied Sciences recently evaluated the effectiveness of a mobile cardiotocography solution (iCTG) in pregnant women at four primary care facilities in the Pwani region. The wireless iCTG was used for continuous monitoring of the foetal heart rate.
Early detection
The results are promising. With iCTG, abnormal foetal heart rate patterns were detected eight to ten times more often than with standard care. In addition, the use of the technology halved the risk of stillbirths and neonatal mortality. Perinatal mortality fell from 6.6 to 2.6 per cent.
According to lead author Yoko Shimpuku, professor at Hiroshima University, the study shows that iCTG is not a “luxury technology”, but a practical and life-saving tool. “Even in resource-limited settings, digital monitoring can demonstrably strengthen perinatal care,” she says. The research was recently published in BMC Public Health.
Wireless technology
The main causes of stillbirths and neonatal mortality in Tanzania are prematurity and hypoxia. In many LMICs, foetal monitoring still relies on expensive, non-mobile equipment or simple fetoscopes, which only allow intermittent auscultation. As a result, critical signs of foetal distress often go unnoticed.
The smart, user-friendly iCTG automatically sends alerts to healthcare providers in the event of abnormalities in the foetal heart rate. This supports timely clinical decision-making. In the event of signs of distress, immediate interventions can be initiated, such as intrauterine resuscitation (repositioning of the mother, administration of fluids and oxygen). In acute situations, rapid referral by ambulance follows, while monitoring continues.
Study design and results
Between October 2023 and September 2024, 763 pregnant women (≥32 weeks) participated in the study in the districts of Kisarawe and Bagamoyo. Of these, 492 women were monitored with iCTG; 271 received standard care. In addition to the decrease in mortality, significantly lower Apgar scores were also observed, indicating fewer respiratory and health problems in newborns.
However, the number of caesarean sections increased in the iCTG group (27.6% versus 10.3%). The researchers therefore emphasise the importance of clear clinical guidelines, so that digital monitoring leads to appropriate, and therefore not unnecessary, interventions.
Scaling up and integration into the care chain
Access to antenatal care (ANC) remains a challenge in LMICs due to financial barriers, distance and limited health literacy. It was striking that women in this study with iCTG actually made fewer ANC visits. According to the researchers, this is because the intervention was introduced late in pregnancy.
For the future, they recommend using iCTG earlier in pregnancy, combined with health education. Hearing their own foetal heartbeat can involve women more actively in their pregnancy and increase the demand for care.
The research group is working on scaling up to larger and more diverse settings while also investigating cost-effectiveness and long-term impact. The ultimate goal is to integrate mobile CTG into routine prenatal and intrapartum care so that every pregnant woman, regardless of where she lives, has access to reliable foetal monitoring and a safer delivery.
