Improving Maternal and Neonatal Outcomes with 3D-Printed Foetoscopes in Kenya

Hourly foetal heart monitoring with individualised 3D-printed fetoscopes in a Kenyan maternity ward improved detection of non-reassuring foetal status, reduced emergency caesarean sections, prevented perinatal deaths and raised satisfaction for mothers and staff. The innovation showed that local 3D printing can deliver low-cost, rapid solutions to equipment shortages, strengthen infection control and enhance health system resilience in resource-limited settings.

Key Points

• Individualised 3D-printed fetoscopes enabled hourly foetal heart monitoring.
• Earlier detection of non-reassuring foetal status reduced emergency caesarean sections.
• No foetal deaths occurred in the group with personalised 3D-printed fetoscopes.
• Maternal and staff satisfaction increased with improved monitoring and outcomes.
• Local 3D printing provided low-cost, rapid solutions to equipment shortages.

Introduction

Caesarean section is a vital surgical procedure used to deliver a baby when a life-threatening condition arises during labour or pregnancy for either the mother or the foetus. According to the World Health Organization, it is often indicated in cases of non-reassuring foetal status, placental abruption or severe pre-eclampsia. It is classified by the American College of Obstetricians and Gynaecologists and the National Institute for Health and Care Excellence as a Category I or II intervention, meaning that delivery should occur within 75 minutes of the decision to operate in order to optimise outcomes.

Over the past four decades, the use of caesarean section has risen steadily across the world. Global prevalence increased from 7% in 1990 to 21% in 2018, with projections suggesting that it could reach 28.5% by 2030. While caesarean section can be life-saving when medically indicated, particularly in the presence of non-reassuring foetal status, cephalopelvic disproportion, malpresentation, hypertensive disorders of pregnancy, prolonged labour, macrosomia or multiple gestation, its rising use is cause for concern. The World Health Organization stated as early as 1985 that there was no justification for any region to have rates higher than 10–15%. Beyond this threshold, increasing numbers of procedures do not bring additional benefits but may instead expose women to greater risks, including higher morbidity and mortality, as well as placing further strain on already limited health resources.

The risks are particularly evident in low- and middle-income countries. In Africa, the average caesarean rate has been reported at 9%, ranging between 0.6% and 18% depending on region and facility type. In Kenya, the national rate is estimated at 14.4%, with the majority performed as emergency operations. A study of 321 Kenyan women undergoing caesarean section found that 89.4% of procedures were emergencies, most commonly for non-reassuring foetal status, prolonged labour or a history of previous caesarean section. Public health facilities tend to report higher emergency rates than private institutions, and the rising use of the procedure across the country has raised significant concerns for maternal and neonatal health.

Non-reassuring foetal status, formerly known as foetal distress, remains a critical determinant of emergency intervention. It is a term used to indicate oxygen deprivation in the foetus, whether temporary or permanent, which can progress to hypoxia and metabolic acidosis. Globally, it affects between 8.9% and 30.7% of pregnancies and is one of the major contributors to stillbirth and early neonatal death. In low- and middle-income countries, where access to timely obstetric care may be limited, the burden is especially severe. Non-reassuring foetal status is also a risk factor for long-term complications such as cerebral palsy.

A number of maternal and obstetric factors contribute to non-reassuring foetal status. These include antepartum haemorrhage, intrauterine growth restriction, amniotic fluid disorders and maternal illnesses. Obstetric interventions can also play a role, with induction or augmentation of labour, use of anaesthesia and the presence of meconium-stained amniotic fluid all associated with increased risk. Tocolytic treatment for preterm labour, particularly when frequent, may further contribute. The most common tool available for assessing foetal wellbeing in labour is foetal heart rate monitoring, either by intermittent auscultation or continuous electronic methods. In many low-resource settings, however, access is limited and intermittent auscultation with a shared foetoscope remains the standard.

Innovation in 3D Printing

Three-dimensional printing, also referred to as additive manufacturing, is a technique that creates physical objects layer by layer based on a digital model file. Unlike traditional manufacturing, which relies on moulds or extensive material removal, 3D printing uses less raw material and allows precise customisation. Once regarded as little more than an ambitious vision, it has become a tangible reality across many areas of healthcare. Today, 3D printing represents a significant opportunity to support pharmaceutical development, enable rapid production of implants and change the way doctors and surgeons prepare for procedures. It allows for personalised devices, faster turnaround and the capacity to innovate locally.

In many hospitals in low- and middle-income countries, such advances remain far removed from daily practice. Basic but essential tools can be in short supply. In Kenyan maternity wards, for example, once a mother is admitted to labour, monitoring of the foetus is done through intermittent auscultation using a foetoscope. For low-risk pregnancies, checks are usually performed every three hours and recorded on the partograph. In many public hospitals, a single foetoscope may be shared between all the women on the ward. Until the COVID-19 pandemic, infection prevention was not a major concern with this practice, but as awareness increased, the sharing of devices was recognised as a potential risk.

This necessity triggered an idea: to individualise foetoscopes, ensuring each mother had her own device at the bedside. The approach would not only reduce the infection risks associated with sharing, but also provide an opportunity to explore whether more frequent monitoring could improve detection of non-reassuring foetal status and reduce the need for emergency caesarean section.

Through a collaboration with the Pennsylvania University School of Engineering, a prototype 3D printer was donated to Uzima University School of Medicine. Using this machine, 32 foetoscopes were fabricated, enough to equip each bed in the maternity ward of Jaramogi Oginga Odinga Teaching and Referral Hospital. The devices were produced within 48 hours, a stark contrast to the lengthy procurement cycles that often characterise equipment supply in public health systems. This intervention represented not only an advance in infection prevention but also a test of how digital fabrication could alter clinical practice in a resource-constrained environment.

Methods

The study was designed as a case-control comparison in order to assess the impact of individualised 3D-printed foetoscopes on foetal heart rate monitoring, identification of non-reassuring foetal status and subsequent maternal and neonatal outcomes.

The prospective case group included 32 mothers admitted to the maternity ward at Jaramogi Oginga Odinga Teaching and Referral Hospital. Each mother was allocated a personalised 3D-printed foetoscope at the bedside, and foetal heart monitoring was conducted hourly throughout labour. Their outcomes were compared with a retrospective control group of 32 mothers, selected randomly from delivery records covering the preceding six months, when only one foetoscope had been available for the entire ward and monitoring was carried out every three hours.

Medical records for both groups were reviewed until the time of discharge following delivery. Data collected included the frequency of foetal examinations, time from admission to detection of non-reassuring foetal status, interventions undertaken, decision-making intervals and maternal and neonatal outcomes.

In addition to clinical data, qualitative information was obtained through interviews with maternity nurses and attending doctors who had been working in the unit during both study periods. They were asked about their experiences before and after the 3D printing intervention, with particular focus on workflow, timeliness of interventions and perceptions of outcomes. This input provided valuable insights into staff perspectives and the practical feasibility of implementing individualised monitoring.

Statistical analysis involved summarising categorical variables with frequency counts and percentages, while continuous variables were described using medians and interquartile ranges. Associations between categorical variables and outcomes were assessed with Pearson’s chi-square or Fisher’s exact tests, as appropriate. For continuous variables, non-parametric Wilcoxon–Mann–Whitney tests were used. The normal foetal heart rate during labour, against which changes were assessed, was defined as 110–160 beats per minute.

Whenever hourly monitoring revealed abnormalities—such as rates above the upper threshold, below the lower threshold, or irregular, muffled or unusually high-volume heart sounds—medical interventions were applied immediately according to the identified cause. These included addressing maternal conditions, pregnancy complications or umbilical cord and placental issues. Only when prompt medical management failed to normalise the situation were mothers taken for emergency caesarean section.

Results

The introduction of individualised 3D-printed foetoscopes in the maternity ward led to clear differences in both monitoring practices and clinical outcomes when compared with the period in which a single shared foetoscope had been used.

With the personalised approach, the frequency of foetal heart rate monitoring increased significantly. Mothers with their own bedside foetoscope were checked on average every 1.3 hours (interquartile range 1.1–1.6), whereas those in the control group with a shared device were checked approximately every 2.5 hours (IQR 1.9–3.9). The difference was highly significant (p < 0.001).

Earlier detection of non-reassuring foetal status was a direct consequence of the increased monitoring frequency. Among mothers with individualised foetoscopes, abnormalities were identified within a median of 1.2 hours (IQR 1.1–1.3), compared with 2.6 hours (IQR 2.3–2.8) in the control group (p < 0.001). The shorter interval allowed for more rapid intervention, often avoiding progression to severe foetal compromise.

This translated into improved maternal and neonatal outcomes. The proportion of mothers requiring emergency caesarean section to save the foetus was lower in the group with individualised foetoscopes, at 13%, compared with 38% among those sharing a device (p = 0.021). Furthermore, no foetal deaths were reported in the case group, while three deaths occurred in the control group, representing 9.4% of cases, although this difference did not reach statistical significance (p = 0.240).

Maternal satisfaction with care was also markedly higher when each mother had her own foetoscope. In the case group, 94% expressed satisfaction, compared with 63% in the control group (p = 0.002). Staff satisfaction was also reported to be higher. Midwives noted that earlier detection of foetal compromise, prompt interventions and better outcomes for both mothers and babies contributed to a sense of professional fulfilment.

The overall effect of introducing 3D-printed foetoscopes was therefore to reduce delays in monitoring, allow earlier identification of non-reassuring foetal status, decrease the proportion of emergency caesarean sections, prevent some perinatal deaths and enhance both maternal and staff experience within the maternity unit.

Discussion

The findings from the maternity unit demonstrate that relatively simple and inexpensive technological innovations can make a significant difference to clinical outcomes in low-resource environments. The provision of individualised 3D-printed foetoscopes allowed for more frequent monitoring, leading to earlier detection of non-reassuring foetal status and reducing the need for emergency caesarean section. This change not only improved outcomes for mothers and newborns but also enhanced the working environment for staff.

From a clinical perspective, the link between more frequent monitoring and reduced emergency interventions is clear. By identifying abnormal foetal heart rate patterns more quickly, staff were able to intervene medically to stabilise the foetus, whether by addressing maternal conditions, managing pregnancy complications, or responding to umbilical cord and placental factors. Only when such interventions were unsuccessful did mothers require surgical delivery. This explains the reduction in emergency caesarean sections and the absence of foetal deaths among mothers monitored with their own foetoscopes. The decline in perinatal deaths also reflects the benefits of earlier recognition and timely action.

The broader implications extend to health systems and hospital management. One of the most striking observations was the difference in cost and accessibility between traditional procurement and local 3D printing. The printer produced 32 foetoscopes within 48 hours, compared with a single shared foetoscope that had been in use for the preceding year despite repeated requisition requests. The cost of producing each device with 3D printing was only a fraction of the price of purchasing a new one from commercial suppliers. This capacity to fabricate essential equipment rapidly and affordably has obvious value in health systems where resources are constrained and supply chains are unreliable.

Beyond cost savings, the intervention also revealed important social and professional dimensions. Mothers expressed greater satisfaction with the care they received, linked both to more attentive monitoring and to better outcomes. Midwives and doctors reported increased satisfaction and morale, as they were able to deliver more babies safely and reduce the stress associated with emergency interventions and poor outcomes. An unexpected finding was the enthusiasm among staff for further use of the 3D printer. Requests were made for the technology to be available for routine use, including the fabrication of spare parts for incubators and other hospital equipment, as well as the production of additional basic tools. This interest highlights how frontline staff recognise the potential of digital fabrication to improve their work environment and service delivery.

The role of 3D printing should also be considered in the wider context of digital health and innovation. In many developing countries, budgets are limited and healthcare competes with other pressing needs for scarce resources. As a result, even simple items such as foetoscopes may not be purchased in adequate numbers. Digital fabrication provides a way to overcome these structural barriers, enabling hospitals to produce what they need in-house and to respond quickly when shortages or breakdowns occur. The experience of using 3D printing for foetoscopes in this maternity unit therefore offers a proof of concept that could be extended to many other areas.

The original study also touched on the potential contribution of artificial intelligence, particularly in developing applications to solve medical problems where laboratory support is not available. While AI was not part of the intervention itself, it is relevant to note that Africa has a high level of smartphone ownership, especially among medical personnel. The combination of accessible AI applications with 3D printing could in future enhance diagnosis, treatment planning and the rapid production of necessary equipment. Although this remains aspirational, it underlines the need to consider digital technologies in an integrated manner.

It is also worth noting that the reduction in emergency caesarean sections has broader implications for maternal health. Caesarean delivery, while often life-saving, is associated with higher risks of morbidity and mortality compared with vaginal birth. According to data from the American College of Obstetricians and Gynaecologists, caesarean delivery carries a maternal mortality rate of 35.9 per 100,000 live births, compared with 9.2 for vaginal delivery. Reducing unnecessary or avoidable caesarean sections is therefore important not only for short-term outcomes but also for long-term maternal health and the sustainability of health systems.

Finally, the experience at Jaramogi Oginga Odinga Teaching and Referral Hospital highlights how technological innovation can support professional pride and motivation. Midwives reported higher levels of satisfaction in their work, not only because outcomes were better, but because they could see almost all of their patients leaving the hospital with healthy babies after normal deliveries. Such morale-boosting effects are valuable in healthcare environments where staff often face heavy workloads and limited resources.

Limitations

While the findings of this study are promising, several limitations must be acknowledged. The relatively small sample size means that the results cannot be generalised without caution. A larger cohort would provide greater statistical power and more confidence in the observed differences.

There is also the possibility of confounding factors that were not controlled for. The timing of cases and controls may have influenced outcomes. Mothers in the case group may have presented directly to Jaramogi Oginga Odinga Teaching and Referral Hospital, whereas mothers in the control group may have been referred after prolonged or non-progressing labours in other facilities. This referral bias could have contributed to higher complication rates among controls.

In addition, while the case group largely included mothers with non-reassuring foetal status as the main indication for caesarean section, the control group may have had other indications, such as breech presentation or cord complications. The presence of multiple indications could have influenced both surgical decisions and outcomes. Neither group was assessed systematically for maternal co-morbidities or foetal conditions, which may also have affected results.

Practical difficulties were encountered during the study. One mother carrying triplets posed challenges for monitoring and interpretation, as it was not always possible to track all foetal heart rates accurately. This made decisions about interventions more complex, and outcomes were not straightforward to classify.

Another limitation relates to the scope of 3D printing itself. The study was limited to producing simple devices such as foetoscopes, but more complex anatomical models were not feasible with the materials available. For example, flexible models of the heart could have provided additional learning opportunities for staff, demonstrating how normal and abnormal heartbeats differ. Although advances in printing materials are closing the gap between reproduced anatomy and real soft tissue, this was not accessible within the study context.

Finally, the study did not attempt to explore the long-term sustainability of 3D printing in the hospital environment. While the devices were produced quickly and cheaply with the donated prototype, questions remain about maintenance, supply of materials and integration into routine hospital operations. Further work is needed to assess how such innovations can be embedded into health systems for lasting benefit.

Conclusion and Recommendations

The experience at Jaramogi Oginga Odinga Teaching and Referral Hospital demonstrated that 3D printing can make a meaningful contribution to maternal and neonatal health in a resource-limited environment. By providing each mother in labour with a personalised foetoscope and enabling hourly monitoring, the intervention improved detection of non-reassuring foetak status, reduced the number of emergency caesarean sections, prevented some perinatal deaths and increased satisfaction for both mothers and healthcare staff.

The wider significance lies in showing that advanced digital technologies need not be restricted to high-income settings. With a single prototype 3D printer, a hospital was able to produce 32 foetoscopes in two days, replacing reliance on a single shared device. The cost of each printed foetoscope was far below the price of procuring equipment through conventional channels, and the immediate availability allowed rapid transformation of practice. In addition to the clinical benefits, the intervention fostered greater confidence and morale among midwives and doctors, who expressed enthusiasm for extending the use of the printer to produce spare parts and other equipment essential for daily service delivery.

For low- and middle-income countries, the implications are clear. Investment in computing and 3D printing offers a practical and cost-effective way to address equipment shortages, overcome procurement delays and strengthen service provision. Hospitals that embrace such technologies can manufacture basic tools, repair equipment and respond quickly to emerging needs. The capacity to innovate locally enhances resilience and reduces dependence on fragile supply chains.

The study also points towards future opportunities. While this intervention was limited to foetoscopes, 3D printing is already being used in other fields to produce implants, prostheses, surgical instruments and training models. With further development, hospitals could integrate digital fabrication into a wide range of clinical and non-clinical departments. In combination with other digital technologies such as artificial intelligence, the potential to transform service delivery is considerable.

On the basis of these findings, it is recommended that health institutions in low- and middle-income countries invest in computing and 3D printing technology, both for training and for clinical service delivery. Hospitals should consider establishing in-house 3D printing facilities to ensure rapid access to essential tools and parts. Non-medical departments could also benefit from testing the technology for their own needs, further embedding digital fabrication into organisational practice.

The twinning of computing with medicine and surgery has the potential to deliver transformational solutions. By embracing 3D printing, healthcare facilities can provide more comprehensive and lifesaving services, making a tangible difference to maternal and neonatal outcomes and strengthening the resilience of health systems in the developing world.

Conflict of Interest

None.