Intrapartum Fetal Cerebral Oximetry and Neuronal Activity – IFCON

For a long time, it has been recognized that events during pregnancy and childbirth influence the health and development of the newborn. There is no doubt that labor is a dangerous period of our life and may result in birth-related disorders. Preterm and postdate deliveries, multiple gestations, preterm rupture of the membranes, intrauterine growth disturbances and intrapartum bleeding are associated with considerable perinatal morbidity and mortality. Healthy newborns with the expected good quality of life are the main goal of modern obstetrics monitoring. A realistic goal of intrapartum fetal surveillance is the diagnosis of fetal exposure to asphyxia and the prevention of morbidity and mortality due to this process. Fetal asphyxia of a particular degree and duration may cause brain damage. At the moment, the diagnosis of intrapartum fetal status requires a blood gas and acid-base assessment. The critical question is the threshold of a metabolic acidosis beyond which fetal brain damage may occur. Likewise, reliable values for fetal brain function sorely lack for obstetricians during childbirth. Early detection of fetal hypoxia/anoxia would undoubtedly improve management. Moreover, in order to understand both normal developments as well as disease processes in the newborn infant it is necessary to have insight into the complex changes that occur in relation to birth. We propose to overcome the limitations of the oximetry, routinely used in clinical units (Recommendation by Agence Nationale de la Sécurité du Médicament et des produits de Santé; ref: I1609910, 2017), namely not to use oximetry as a single method to supervise the patient but to combine it with other methods. We propose the complementary technologies [i.e. combined fetal monitoring (EEG-NIRS)] during labor for the first time. This kind of monitoring will provide the safer and more efficient way of supervision of the fetus during labor, considering to the recommended strategy (ANSM). The aim is to develop a reliable tool for measuring cerebral oximetry simultaneously with neuronal electrical activity at the time of delivery and to bring this tool into the operating phase upstream of a national PHRC. The strategy implemented in this consortium combines the skills of different academic fields grouped within the INSERM U 1105 unit (Neurophysiologists, obstetricians, biomedical engineers and signal processing specialists) and within the LETI / CEA (optical engineering) together with the skills of an industrial partner (Seenel Imaging) whose activity is centered on the development of multimodal tools for the analysis of brain activity. This is undoubtedly an additional asset for the success of this project.