Introducing the Moyo device for intrapartum fetal heart rate monitoring among women with high-risk pregnancies in a low-resource setting: a quasi-experimental study
8 affiliations
- 1Department of Community and Public Health, Busitema University, Mbale, Uganda
- 2AMANI-Accelerating Health Innovations, Mbale, Uganda
- 3Department of Research, Nikao Medical Center, Kampala, Uganda
- 4Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
- 5Department of Nursing, Kabale University, Kabale, Uganda
- 6Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- 7Department of Internal Medicine, Mbale Regional Referral Hospital, Mbale, Eastern Region, Uganda
- 8Department of Women’s and Children’s Health, University of Liverpool, Liverpool, UK
Abstract
Objective: To assess the effect of introducing the Moyo device for continuous intrapartum fetal heart rate monitoring (FHRM) on the detection of abnormal fetal heart rate patterns and perinatal mortality.
Design: We conducted a quasi-experimental quality improvement project using a before-and-after approach. During the preimplementation phase, intermittent FHRM was done using the existing standard of care (Pinard or a hand-held fetal Doppler). In the postimplementation phase, we introduced the Moyo device (Laerdal Global Health, Stavanger, Norway) for continuous intrapartum FHRM. We used the non-participant observation technique to collect data.
Setting: Mbale Regional Referral Hospital in Eastern Uganda, 6 November 2023 to 17 August 2024.
Participants: We enrolled 1544 women with high-risk pregnancies.
Primary and secondary outcome measures: The primary outcome was perinatal mortality, defined as death in labour and up to 24 hours postnatal. The secondary outcomes included detection of abnormal fetal heart rates, Apgar scores less than 7 at 1 and 5 min and mode of birth. We conducted generalised linear regression models of the binomial family with a log link and robust variance estimation.
Results: Mortality preimplementation was 5.1%; following the introduction of the Moyo device, it fell to 3.2%, a non-statistically significant reduction of 37% (adjusted prevalence ratios (aPRs): 0.63 (95% CI 0.39 to 1.02)). There was a 14.8% increase in the number of women whose fetal heart rate was monitored and documented during the postimplementation period (81.1% vs 95.9%) and detection of abnormal fetal heart rate was increased by 41% (aPR: 1.41 (95% CI 1.10 to 1.82)). The rate of caesarean section deliveries was similar in the preimplementation and postimplementation period (59.5% vs 63.1%, p=0.144). Newborn morbidities were lower in the postimplementation phase compared with the preimplementation phase: Apgar score <7 at 1 min (aPR: 0.67; 95% CI 0.54 to 0.85), Apgar score <7 at 5 min (aPR: 0.57; 95% CI 0.39 to 0.84), transfer of newborn to postnatal ward (aPR: 1.11; 95% CI 1.05 to 1.17), and transfer of newborn to the neonatal unit (aPR: 0.72; 95% CI 0.59 to 0.87).
Conclusions: Introduction of the Moyo device for continuous FHRM was associated with a reduction in perinatal morbidity among women with high-risk pregnancies. We recommend a stepped-wedge trial to evaluate the cost-effectiveness of scaling up the use of Moyo in lower-health facilities.
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BibTeX
@article{nantale2026introducing,
title = {{Introducing the Moyo device for intrapartum fetal heart rate monitoring among women with high-risk pregnancies in a low-resource setting: a quasi-experimental study}},
author = {Ritah Nantale and David Mukunya and Julius N Wandabwa and Agnes Napyo and Albert Ssesanga and Eunice Akello and Kenneth Tulya-Muhika Mugabe and Brenda Nambozo and Faith Oguttu and John Stephen Obbo and Andrew Weeks and Milton W Musaba},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2025-099069},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2025-099069},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Introducing the Moyo device for intrapartum fetal heart rate monitoring among women with high-risk pregnancies in a low-resource setting: a quasi-experimental study
AU - Ritah Nantale
AU - David Mukunya
AU - Julius N Wandabwa
AU - Agnes Napyo
AU - Albert Ssesanga
AU - Eunice Akello
AU - Kenneth Tulya-Muhika Mugabe
AU - Brenda Nambozo
AU - Faith Oguttu
AU - John Stephen Obbo
AU - Andrew Weeks
AU - Milton W Musaba
PY - 2026
DA - 2026/10/05
JO - BMJ Open
DO - 10.1136/bmjopen-2025-099069
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2025-099069
AB - Objective: To assess the effect of introducing the Moyo device for continuous intrapartum fetal heart rate monitoring (FHRM) on the detection of abnormal fetal heart rate patterns and perinatal mortality. Design: We conducted a quasi-experimental quality improvement project using a before-and-after approach. During the preimplementation phase, intermittent FHRM was done using the existing standard of care (Pinard or a hand-held fetal Doppler). In the postimplementation phase, we introduced the Moyo device (Laerdal Global Health, Stavanger, Norway) for continuous intrapartum FHRM. We used the non-participant observation technique to collect data. Setting: Mbale Regional Referral Hospital in Eastern Uganda, 6 November 2023 to 17 August 2024. Participants: We enrolled 1544 women with high-risk pregnancies. Primary and secondary outcome measures: The primary outcome was perinatal mortality, defined as death in labour and up to 24 hours postnatal. The secondary outcomes included detection of abnormal fetal heart rates, Apgar scores less than 7 at 1 and 5 min and mode of birth. We conducted generalised linear regression models of the binomial family with a log link and robust variance estimation. Results: Mortality preimplementation was 5.1%; following the introduction of the Moyo device, it fell to 3.2%, a non-statistically significant reduction of 37% (adjusted prevalence ratios (aPRs): 0.63 (95% CI 0.39 to 1.02)). There was a 14.8% increase in the number of women whose fetal heart rate was monitored and documented during the postimplementation period (81.1% vs 95.9%) and detection of abnormal fetal heart rate was increased by 41% (aPR: 1.41 (95% CI 1.10 to 1.82)). The rate of caesarean section deliveries was similar in the preimplementation and postimplementation period (59.5% vs 63.1%, p=0.144). Newborn morbidities were lower in the postimplementation phase compared with the preimplementation phase: Apgar score <7 at 1 min (aPR: 0.67; 95% CI 0.54 to 0.85), Apgar score <7 at 5 min (aPR: 0.57; 95% CI 0.39 to 0.84), transfer of newborn to postnatal ward (aPR: 1.11; 95% CI 1.05 to 1.17), and transfer of newborn to the neonatal unit (aPR: 0.72; 95% CI 0.59 to 0.87). Conclusions: Introduction of the Moyo device for continuous FHRM was associated with a reduction in perinatal morbidity among women with high-risk pregnancies. We recommend a stepped-wedge trial to evaluate the cost-effectiveness of scaling up the use of Moyo in lower-health facilities.
SN - 2044-6055
SN - 2044-6055
ER -