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Med."],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Cardiotocography (CTG) is essential for monitoring high-risk pregnancies, yet perinatal asphyxia prediction accuracy remains limited to 50\u201355%. Regions of artifacts (missing valid signals)-including signal processing aberrations-possibly contribute to this limitation, highlighted by 40% of FDA reports on intrapartum stillbirths. This cohort study applied causal inference to two digitized CTG databases, analyzing 36,792 labor episodes (&gt;36 weeks) at a tertiary Australian hospital (2010\u20132021) and externally validating on a Czech dataset (<jats:italic>n<\/jats:italic>\u2009=\u2009552).High rates of missing valid signals (&gt;30% fetal heart rate signal dropout or &gt;1% maternal-fetal heart rate coincidence) was independently associated with asphyxia (aOR 1.47, 95% CI 1.19\u20131.81); dropout &gt;30% showing stronger link (aOR 1.58, 95% CI 1.13\u20132.20 Australian dataset; aOR 2.30, 95% CI 1.08\u20134.91 Czech dataset). Risk of asphyxia increased with higher dropout (&gt;37.45%, aOR 2.21 Australian dataset; &gt;34.01%, aOR 4.08 Czech dataset). Integrating measures of missing valid signals into fetal monitoring algorithms may improve decision-making and neonatal outcomes.<\/jats:p>","DOI":"10.1038\/s41746-025-01665-4","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T08:22:55Z","timestamp":1746087775000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of missing electronic fetal monitoring signals on perinatal asphyxia: a multicohort analysis"],"prefix":"10.1038","volume":"8","author":[{"given":"Debjyoti","family":"Karmakar","sequence":"first","affiliation":[]},{"given":"Lochana","family":"Mendis","sequence":"additional","affiliation":[]},{"given":"Emerson","family":"Keenan","sequence":"additional","affiliation":[]},{"given":"Marimuthu","family":"Palaniswami","sequence":"additional","affiliation":[]},{"given":"Roxanne","family":"Hastie","sequence":"additional","affiliation":[]},{"given":"Enes","family":"Makalic","sequence":"additional","affiliation":[]},{"given":"Fiona","family":"Brownfoot","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2025,5,1]]},"reference":[{"key":"1665_CR1","doi-asserted-by":"publisher","first-page":"347","DOI":"10.3390\/biomedicines10020347","volume":"10","author":"D Mota-Rojas","year":"2022","unstructured":"Mota-Rojas, D. et al. 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F.B. and E.K. are directors and shareholders of Kali Healthcare, a company that is commercializing a wearable fetal monitoring device. M.P. is a shareholder of Kali Healthcare. Rest of the authors have nothing to disclose.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"233"}}