About Dawes-Redman

Early days

Professor Chris Redman gained his degree in Natural Sciences at Cambridge University, transferred half way through his course to study Medicine and graduated in 1967 with the intention of becoming a paediatrician. As Junior Lecturer in the Department of the Regius Professor of Medicine in Oxford he was offered the opportunity to carry out a trial of the treatment of high blood pressure in pregnancy.

It was then that he encountered his first cases of early onset pre-eclampsia and was appalled to discover how little was known about the condition and how haphazard was the management. He gave up his ambitions to train in Paediatrics and started a long term commitment to discover better care for pre-eclamptic women. He continues this interest to this day.

How pre-eclampsia triggered a life-long interest in cardiotocography

In the early 1970s, early onset pre-eclampsia needing delivery before 34 weeks was a death sentence for the baby, either because of intra-uterine death or neonatal death at a time when neonatal intensive care was not well developed.

A major problem was to know about the well-being of the baby. So when the first electronic fetal heart rate monitors arrived, for use in labour, it was a quick development to find out whether or not they worked before labour.

In brief, as far as Professor Chris Redman was concerned they were magic. It was easy to see the dying baby (now called a terminal trace). Better outcomes followed immediately.

Non-reassuring cardiotocograms and computerisation of the antepartum CTG

But many more traces were neither normal nor reassuring – now called ‘non-reassuring’. They were hard to study, even harder when the task of standardizing visual opinions was confronted.

This was the drive to develop the first computerized system for antepartum fetal heart rate analysis and monitoring 35 years ago with Professor Geoffrey Dawes. Now called the Dawes-Redman system it was marketed in 1991 and is still the world leader for this type of application. It allowed the greyness in the grey zone to be calibrated.

A unique archive for computerized CTG. 

In 1991 electronic details of clinical outcome were not available to match those of the digital records of the cardiotocograms. So Professor Chris Redman designed OXMAT as the hospital electronic birth register which was robust and lasted for nearly 21 years. It succeeded an earlier system of which he was director starting in 1975. He has since been active in the creation of various databases including OXMAT2. The Oxford Computerised CTG Archive is the jewel containing well over 100,000 cases of digital CTGs and detailed electronic outcome. 

Retirement

He retired in 2009 and is now Emeritus Professor of Obstetric Medicine at Oxford University UK.  

However he continues to be active in computerized CTG development and pre-eclampsia research 

 Who was Dawes?

 
Geoffrey Dawes (1918-1996) was a formidable man with a big presence. His life work was the study of fetal and neonatal physiology in lambs which could be investigated while they remained in utero, after the insertion of catheters to study different aspects of their circulatory, cardiac, pulmonary or brain functions. For this he gained an international reputation, many awards and other formal recognition of his achievements and was elected a Fellow of the Royal Society. He studied in Oxford University during the 2nd world war, completed his medical training but was rejected for military service because of asthma. His future in Oxford was decided, when in 1948 he was appointed the first and surprisingly youthful director of the newly formed Nuffield Institute for Medical Research in Oxford where he worked for the next 37 years.

He was one of the first to observe that the fetal lamb had sleep cycles as well as breathing movements in utero, and within a short time confirmed that the human fetus behaved similarly.

He became involved with me in 1977 at a small meeting in Oxford, when I informally presented myambitions to computerise the fetal heart rate recorded on a clinical CTG. Geoffrey rejected the idea outright as unachievable but was later persuaded by me that it could be done, After that he set to work, driven by his restless intellect and energy. It was not long before very small and simple desktop computers were recordingand analysing the outputs from Hewlett Packard CTG devices. 

He was a skilled mathematician and enjoyed the numerical challenges of describing the complexities of human fetal heart rate patterns. He was fascinated by the need to understand the physiological mechanisms underlying the short and long term variations in the heart rate of the healthy human foetus and the ability to use changes induced by spontaneous hypoxaemia to detect fetal distress in utero and made these concepts an in integral part of the ‘Dawes-Redman’ diagnostic system. He retired in 1985, but in fact did not ‘retire’

Instead he continued his work on our system. I presented him with endless clinical problems from the high risk unit, as reflected in the CTG traces while he sought mathematical ways of describing them. Then we clinically tested how they performed. He was a familiar figure in the department of Obstetrics at the Oxford John Radcliffe Hospital, participated in clinical case conferences and continued to chide his clinical colleagues for their preference for subjective impressions rather than objective numerical measurements of fetal heart rate patterns. 

He was always open to new ideas, had a precise and detailed memory and an unremitting dislike for thoughtlessness and ignorance. His encounters with the latter stimulated his asthmatic wheeziness. It was a familiar signal of his mood when he suddenly delved into his pocket to find and start puffing on his inhaler. He enjoyed international meetings and was still much sought as a speaker until his final year. With his scholarly intellect, great integrity and questing spirit, he was also a kind and humorous man who appreciated and helped younger researchers and thrived in the company of like-minded scientists around the world. He enjoyed fly fishing and gardening. 

On Friday 3 May 1996 he dropped into my office briefly to discuss what to do next. As ever he was excited by the possibilities and keen to move on as quickly as possible. In the early hours of the following Monday, without warning, he had the massive stroke that killed him later that day.

To the end of our collaboration it was as if I was one of his ‘students’ and he my mentor. Our DR-CTG system is his splendid memorial.

Professor Chris Redman 16/01/21