{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:07:11Z","timestamp":1791209231562,"version":"4.1.0"},"reference-count":24,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005627","name":"Thrasher Research Fund","doi-asserted-by":"publisher","award":["ID#01851"],"award-info":[{"award-number":["ID#01851"]}],"id":[{"id":"10.13039\/100005627","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,5]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Mbale Regional Referral Hospital in Eastern Uganda, 6 November 2023 to 17 August 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We enrolled 1544 women with high-risk pregnancies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>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\u2009min and mode of birth. We conducted generalised linear regression models of the binomial family with a log link and robust variance estimation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 &lt;7 at 1\u2009min (aPR: 0.67; 95%\u2009CI 0.54 to 0.85), Apgar score &lt;7 at 5\u2009min (aPR: 0.57; 95%\u2009CI 0.39 to 0.84), transfer of newborn to postnatal ward (aPR: 1.11; 95%\u2009CI 1.05 to 1.17), and transfer of newborn to the neonatal unit (aPR: 0.72; 95%\u2009CI 0.59 to 0.87).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-099069","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:35:16Z","timestamp":1791207316000},"page":"e099069","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"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"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8433-7054","authenticated-orcid":false,"given":"Ritah","family":"Nantale","sequence":"first","affiliation":[{"name":"Department of Community and Public Health, Busitema University, Mbale, Uganda"},{"name":"AMANI-Accelerating Health Innovations, Mbale, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3892-9777","authenticated-orcid":false,"given":"David","family":"Mukunya","sequence":"additional","affiliation":[{"name":"Department of Community and Public Health, Busitema University, Mbale, Uganda"},{"name":"AMANI-Accelerating Health Innovations, Mbale, Uganda"},{"name":"Department of Research, Nikao Medical Center, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius N","family":"Wandabwa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes","family":"Napyo","sequence":"additional","affiliation":[{"name":"Department of Nursing, Kabale University, Kabale, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Ssesanga","sequence":"additional","affiliation":[{"name":"Department of Community and Public Health, Busitema University, Mbale, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunice","family":"Akello","sequence":"additional","affiliation":[{"name":"Department of Community and Public Health, Busitema University, Mbale, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth Tulya-Muhika","family":"Mugabe","sequence":"additional","affiliation":[{"name":"AMANI-Accelerating Health Innovations, Mbale, Uganda"},{"name":"Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Nambozo","sequence":"additional","affiliation":[{"name":"AMANI-Accelerating Health Innovations, Mbale, Uganda"},{"name":"Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faith","family":"Oguttu","sequence":"additional","affiliation":[{"name":"Department of Community and Public Health, Busitema University, Mbale, Uganda"},{"name":"AMANI-Accelerating Health Innovations, Mbale, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Stephen","family":"Obbo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mbale Regional Referral Hospital, Mbale, Eastern Region, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Weeks","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4145-4044","authenticated-orcid":false,"given":"Milton W","family":"Musaba","sequence":"additional","affiliation":[{"name":"AMANI-Accelerating Health Innovations, Mbale, Uganda"},{"name":"Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"2026100506351051000_16.10.e099069.1","unstructured":"Still births. 2022 Available: https:\/\/www.who.int\/health-topics\/stillbirth"},{"key":"2026100506351051000_16.10.e099069.2","unstructured":"Newborn mortality. 2024 Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/newborn-mortality"},{"key":"2026100506351051000_16.10.e099069.3","unstructured":"Ministry of Health u: Annual Health sector performace report In: Goverment of Uganda. 2019."},{"key":"2026100506351051000_16.10.e099069.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0019674","article-title":"Perinatal mortality in eastern Uganda: a community based 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WHO recommendations: intrapartum care for a positive childbirth experience. 2018."},{"key":"2026100506351051000_16.10.e099069.8","unstructured":"Organization WH: Standards for improving quality of maternal and newborn care in health facilities. 2016."},{"key":"2026100506351051000_16.10.e099069.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0205698","article-title":"Implementation of a novel continuous fetal Doppler (Moyo) improves quality of intrapartum fetal heart rate monitoring in a resource-limited tertiary hospital in Tanzania: An observational study","volume":"13","author":"Kamala","year":"2018","journal-title":"PLoS One"},{"key":"2026100506351051000_16.10.e099069.10","doi-asserted-by":"crossref","first-page":"341","DOI":"10.2147\/IJWH.S160675","article-title":"Intrapartum fetal heart rate monitoring using a handheld Doppler versus Pinard stethoscope: a randomized controlled study in Dar es Salaam","volume":"10","author":"Kamala","year":"2018","journal-title":"Int J Womens Health"},{"key":"2026100506351051000_16.10.e099069.11","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0219573","article-title":"Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy","volume":"14","author":"Blix","year":"2019","journal-title":"PLoS One"},{"key":"2026100506351051000_16.10.e099069.12","doi-asserted-by":"crossref","DOI":"10.1080\/16549716.2020.1711618","article-title":"Fetal heart rate monitoring practices at a public hospital in Northern Uganda - what health workers document, do and say","volume":"13","author":"Ayebare","year":"2020","journal-title":"Glob Health Action"},{"key":"2026100506351051000_16.10.e099069.13","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-041071","article-title":"Implementation of the Moyo fetal heart rate monitor in district hospitals in Bihar, India: a feasibility study","volume":"11","author":"Oommen","year":"2021","journal-title":"BMJ Open"},{"key":"2026100506351051000_16.10.e099069.14","unstructured":"Moyo Fetal Heart Rate Monitor. 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Risk of bias assessment in credible quasi-experimental studies1. 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