Comparison of a Novel Computerized Analysis Program and Visual Interpretation of Cardiotocography

Abstract

ObjectiveTo compare a novel computerized analysis program with visual cardiotocography (CTG) interpretation results.MethodsSixty-two intrapartum CTG tracings with 20- to 30-minute sections were independently interpreted using a novel computerized analysis program, as well as the visual interpretations of eight obstetricians, to evaluate the baseline fetal heart rate (FHR), baseline FHR variability, number of accelerations, number/type of decelerations, uterine contraction (UC) frequency, and the National Institute of Child Health and Human Development (NICHD) 3-Tier FHR classification system.ResultsThere was no significant difference in interobserver variation after adding the components of computerized analysis to results from the obstetricians' visual interpretations, with excellent agreement for the baseline FHR (ICC 0.91), the number of accelerations (ICC 0.85), UC frequency (ICC 0.97), and NICHD category I (kappa statistic 0.91); good agreement for baseline variability (kappa statistic 0.68), the numbers of early decelerations (ICC 0.78) and late decelerations (ICC 0.67), category II (kappa statistic 0.78), and overall categories (kappa statistic 0.80); and moderate agreement for the number of variable decelerations (ICC 0.60), and category III (kappa statistic 0.50).ConclusionsThis computerized analysis program is not inferior to visual interpretation, may improve interobserver variations, and could play a vital role in prenatal telemedicine.

Combination of XGBoost Analysis and Rule-Based Method for Intrapartum Cardiotocograph Classification

“…The clinical CTG signals were divided into category I, II & III by the rule-based method on the features such as baseline, variability, acceleration, and deceleration following NICHD and Chen, C. Y. [12] definition. In order to reduce the processing time, we modified and simplices the rule as Table 1.…”

“…FHR variability with 0 beats per minute (bpm) does not exist in the living fetus, and we used the definition of Chen et al, with an amplitude of 2 bpm as BVA, an amplitude between 2-5 bpm as BVMI, it means that the fetus may have been neurologically harmed due to hypoxia [15]. An amplitude between 6-25 bpm as BVMO, an amplitude more than 25 bpm as BVMA [12]. The BV is calculated by the equation (2) of the difference between the FHR maximum and minimum values in every minute.…”

“…Five parameters were defined from the extraction of the time and frequency domains, as well as the morphological features. In this section, FHR features were extracted based on the NICHD criteria [12]. The algorithm used for feature extraction and classification in this study was developed and program implemented by MATLAB (version 9.9.0.1495850, R2020b, Natick, Massachusetts, The MathWorks Inc.).…”

“…In this study, researchers collected CTG data before delivery and compared the CTG data with the visual interpretations from 8 obstetricians, and the results showed the average statistics kappa value of category I, II, III, and overall were respectively 0.89, 0.78, 0.50 and 0.79. Compared with the traditional classification method, the kappa value here was higher (0.15-0.38), but the value of category III was lower [12]. In 2016, according to RCOG, a Malaysian research team classified a group of pregnant women into normal, suspicious and pathological categories, and analyzed the baseline, variability, deceleration, acceleration based on FHR to construct an instant classification system [11].…”

“…Other studies have shown that there is a correlation between prenatal and fetal physiological signals and FD [9][10][11][12][13][14][15], for example, cardiotocograph (CTG) signals can assist obstetricians and nurses in clinical interpretation. CTG is mainly used as a clinical reference for fetal health and FD [9] by monitoring the changes of Uterine Contraction (UC) and Fetal Heart Rate (FHR) of pregnant women.…”