Title Page Type of Manuscript: Letter to the Editor Title: Augmenting Intrauterine Monitoring with Artificial Intelligence: A New Era in Fetal SurveillanceAuthors and Affiliations1. Author 1 – Reem MuhammadAffiliation: Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan ORCID: 0009-0003-4803-13752. Author 2 – Hiba Kamran Affiliation: Islamic International Medical College, Riphah International University, Rawalpindi, PakistanORCID ID: 0009-0009-1152-90933. Author 3 – Zahra Ali HaqueAffiliation: Islamic International Medical College, Riphah International University, Rawalpindi, PakistanORCID: 0009-0002-3146-8282@Corresponding author: Reem Muhammad E-mail: reemmuhammadk@gmail.com Mobile phone: +923325552620Key words: Chorioamnionitis, Intrauterine Monitoring, Neonatal Outcomes, Artificial Intelligence (AI), Uterine ContractilityFunding: NoneMain Manuscript:Dear Dr. Aris Papageorghiou,Chorioamnionitis (CA), or Intra-amniotic infection (IAI), is a significant cause of maternal and neonatal morbidity. In a recent study, Juhantalo et al. found compelling evidence that fetal distress during labours complicated by chorioamnionitis can be reduced by utilizing intrauterine (IT) monitoring compared to external tocodynamometry (ET).1 Building on their finding, we propose a hybrid model that combines intrauterine monitoring with Artificial Intelligence (AI), further enhancing fetal monitoring and diagnostic precision.AI and Machine Learning (ML) have notably improved the diagnosis of complex obstetric conditions such as CA. Fetal inflammatory response, a key marker of CA, can be identified with a balanced accuracy of 0.836 using deep learning models trained on umbilical cord histopathology, which precisely identifies diagnostic regions such as the umbilical arteries.2 Early and accurate detection is vital, as timely intervention can reduce the risk of maternal and neonatal complications, including preterm birth, neonatal sepsis, and long-term neurodevelopmental impairments. AI-driven alert systems can detect declining uterine efficiency or early signs of fetal distress earlier than traditional benchmarks, such as those utilized by Juhantalo et al., including Montevideo units (MVU) or contraction frequency. AI integration could enable clinicians to customize oxytocin dosing, initiate timely antibiotic therapy, and make more accurate decisions regarding delivery methods.Furthermore, radiological findings and inflammatory markers, like C-reactive protein (CRP) and procalcitonin can be added into AI predictive models to further enhance diagnosis. Intrapartum fever and maternal inflammatory responses, clinical hallmarks of CA can be studied and analyzed using machine learning algorithms via the utilization of electronic health record data and clinical biomarkers.3,4 Latest innovations, like convolutional neural networks (CNNs) that analyze histologic slides for fetal inflammatory response syndrome, have showcased high reliability and understanding, offering a nuanced approach towards automation and standardization of CA diagnosis at the tissue level.4These models can detect subtle, small patterns that conventional diagnostic workflows might not detect by consistently analyzing large datasets, hence improving diagnostic accuracy and enabling more personalized patient care.While we commend Juhantalo et al. for their valuable insights, prospective studies should integrate AI-driven systems during labor to evaluate their potential to improve delivery outcomes, neonatal morbidity, and diagnostic accuracy on diverse patient cohorts. Validating AI models on diverse datasets would ensure generalizability and advance perinatal care beyond the capabilities of monitoring modalities alone; however, more research is required to understand its effectiveness and limitations in real-world clinical settings.