Continuous Remote Vital Sign Monitoring During Labour Analgesia With Remifentanil - a Prospective Observational Study

Introduction Remifentanil, a potent, ultra-short-acting opioid, administered intravenously via patient-controlled analgesia (PCA) has been used for more than a decade in several countries, particularly in Switzerland and at the Ulster Hospital in Ireland. In 2024, remifentanil was formally included as a standard option for labour analgesia in the United Kingdom and incorporated into the guidelines from the National Institute for Health and Care Excellence (NICE). The REMIPCA SAFE Network collaboration has further demonstrated that remifentanil PCA is a safe and effective method for labour analgesia, offering rapid onset, patient autonomy, and high maternal satisfaction (remiPCA.org).

In many European and Anglophone countries, nitrous oxide and epidural analgesia remain the most commonly used pharmacological methods for labour analgesia, while the use of remifentanil is not yet widespread in all settings. Nitrous oxide cause nausea and is under increasing scrutiny due to environmental concerns, while epidural analgesia, although highly effective for pain relief, is more invasive, resource intensive and associated with rare but severe complications.

Remifentanil PCA represents a well-tolerated, effective and valuable option for labour analgesia, yet its wider implementation is still limited by concerns of opioid side-effects particularly the risk of respiratory depression leading to desaturation, potentially affecting the foetus. Thus, continuous one-to-one observation and monitoring in the delivery room, with the midwife unable to leave the patient unattended, is recommended. Such constant one-to-one monitoring may be challenging in present health-care settings where staffing constraints may limit the implementation of remifentanil as routine obstetric care.

Continuous remote vital sign monitoring to display oxygen saturation (SpO₂), respiratory rate, and heart rate on a handheld device (smartphone), has the potential to address this barrier by allowing the midwife to leave the labour room for short, predefined intervals while maintaining continuous surveillance of maternal vital signs. Such an approach could free staff resources without compromising patient safety. While centralised foetal monitoring (CTG) is standard practice in many units, the application of continuous remote vital sign monitoring for women receiving remifentanil during labour has, to our knowledge, never been formally studied.

Objectives The aim is to study whether remote monitoring during remifentanil for labour analgesia affects the incidence of maternal desaturation and other safety outcomes (bradypnoea, bradycardia, and neonatal outcomes, assessed via Apgar scores and umbilical cord pH.) This will be assessed in a setup where remifentanil PCA for labour analgesia is given and the midwife is allowed maximum absence intervals of 10 minutes with predefined criteria for when the woman must be accompanied (e.g., if SpO₂ < 94%, supplemental oxygen >2L/min., or decreased consciousness) and compared with a control group where the midwife is in the labour room continuously.