Increasing rate of Caesarean Section Due to Non-Reassuring Cardiotocography

Objective: To evaluate increasing rate of caesarean section due to non-reassuring cardiotocography. Methods: This study is carried out in obs/gyn department of Liaquat university hospital from 2012 to 2013. After permission from ERC, patients enrolled for study meeting inclusion criteria with non-reactive cardiotocography undergo caesarean section, and results are analysis through SSPS version 17. Results: There was wide variation of maternal age ranging from a minimum of 20 years to 30 years. The mean age was 26 ± 2.1 years. In our study mostly patients were primigravida 58 (58%) between 2 - 4 were 22 (22%) more than para 5 were 20 (20%) patients. In our study mostly patients undergone caesarean section 81 (81%) 19 delivered vaginally (19%). In our study the gestational age was >37 weeks, ranging from a minimum of 37 weeks to 42 weeks. The mean age was 37 + 2.4 week. Mostly patients observed 37 - 38 wks in (52.67%), 39 - 40 wks in (32.14%) and 41 - 42 wks in (15.17%). In our study mostly Apgar score were more than 7 was 63 (63%) cases and less than 7 Apgar score in 37 (37%). Conclusion: Cardiotocography is a useful and indispensable adjunct to monitor the condition of endangered fetus. However, there is a need to develop a standardized and unambiguous definition of FHR tracing to reduce the incidence of false positive findings that may result in increased incidence of unnecessary intervention particularly caesarean section.

Federated Machine Learning Based Fetal Health Prediction Empowered with Bio-Signal Cardiotocography

Cardiotocography measures the fetal heart rate in the fetus during pregnancy to ensure physical health because cardiotocography gives data about fetal heart rate and uterine shrinkages which is very beneficial to detect whether the fetus is normal or suspect or pathologic.Various cardiotocography measures infer wrongly and give wrong predictions because of human error.The traditional way of reading the cardiotocography measures is the time taken and belongs to numerous human errors as well.Fetal condition is very important to measure at numerous stages and give proper medications to the fetus for its well-being.In the current period Machine learning(ML)is a well-known classification strategy used in the biomedical field on various issues because ML is very fast and gives appropriate results that are better than traditional results.ML techniques play a pivotal role in detecting fetal disease in its early stages.This research article uses Federated machine learning(FML)and ML techniques to classify the condition of the fetus.This study proposed a model for the detection of bio-signal cardiotocography that uses FML and ML techniques to train and test the data.So,the proposed model of FML used numerous data preprocessing techniques to overcome data deficiency and achieves 99.06%and 0.94%of prediction accuracy and misprediction rate,respectively,and parallel the proposed model applying K-nearest neighbor(KNN)and achieves 82.93%and 17.07%of prediction accuracy and misprediction accuracy,respectively.So,by comparing both models FML outperformed the KNN technique and achieved the best and most appropriate prediction results as compared with previous studies the proposed study achieves the best and most accurate results.

Machine Learning Prediction of Fetal Health Status from Cardiotocography Examination in Developing Healthcare Contexts

Reducing neonatal mortality is a critical global health objective,especially in resource-constrained developing countries.This study employs machine learning(ML)techniques to predict fetal health status based on cardiotocography(CTG)examination findings,utilizing a dataset from the Kaggle repository due to the limited comprehensive healthcare data available in developing nations.Features such as baseline fetal heart rate,uterine contractions,and waveform characteristics were extracted using the RFE wrapper feature engineering technique and scaled with a standard scaler.Six ML models—Logistic Regression(LR),Decision Tree(DT),Random Forest(RF),Gradient Boosting(GB),Categorical Boosting(CB),and Extended Gradient Boosting(XGB)—are trained via cross-validation and evaluated using performance metrics.The developed models were trained via cross-validation and evaluated using ML performance metrics.Eight out of the 21 features selected by GB returned their maximum Matthews Correlation Coefficient(MCC)score of 0.6255,while CB,with 20 of the 21 features,returned the maximum and highest MCC score of 0.6321.The study demonstrated the ability of ML models to predict fetal health conditions from CTG exam results,facilitating early identification of high-risk pregnancies and enabling prompt treatment to prevent severe neonatal outcomes.

Community Hospital Experience of Surgical Times and Outcomes in Patients Undergoing Cesarean Deliveries for Non-Reassuring Fetal Tracing: A Retrospective Cohort

Background: Current guidelines recommend regional anesthesia versus general as a method of choice for women undergoing cesarean deliveries (CS). However, little is known about the surgical times in the operating room and a choice of anesthesia for cesarean deliveries. Objective: This study was designed to compare times from the arrival to the OR to the delivery of the fetus between regional and general anesthesia along with maternal and fetal outcomes, for patients undergoing cesarean sections for non-reassuring fetal tracing. Study Design: Records were reviewed for patients who underwent cesarean delivery for non-reassuring fetal heart rate tracing from February 2012 to May 2018. A total of 190 charts were selected. Seven patients who received epidural or spinal anesthesia and then converted to general anesthesia (GA) were excluded. The primary outcomes were: 1) entering the operating room to skin incision (min);2) the time from entering the operating room to delivery of the fetus (min). These times were compared among the patients who underwent epidural, spinal and general anesthesia. The secondary criteria included time from skin incision to delivery of the fetus (min), estimated blood loss (ml), Apgars scores, Arterial/venous cord pH, NICU admissions and fetal complications. ANOVA or Kruskal-Wallis Test was used for the continuous variable and Fisher’s exact test was used for the categorical variable to test the differences between groups. Logistic regression model was used for the binary outcomes after adjusting for age, BMI and number of prior laparotomies. Results: Infants in the GA group were delivered significantly faster when compared to epidural and spinal group separately with a P-value of 0.001. The mean time from arrival to OR to delivery of the newborn in GA group was 12.7 minutes, compared to 27 minutes in epidural group and 32.7 minutes in the spinal group. Time intervals from time in the OR to incision and time from incision to delivery of the fetus were also calculated and were significantly shorter in the GA group when compared to spinal and epidural groups, P Conclusion: The induction of general anesthesia for emergency cesarean section resulted in shorter times to delivery compared to spinal and epidural. General anesthesia was associated with lower, albeit not statistically significant Apgar scores and higher NICU admissions, and had similar cord gases compared to neuraxial anesthesia group.

Abnormal Placental Findings Associated with Non-Reassuring Fetal Monitoring and Excellent Neonatal Outcomes

Objective: Obstetricians, Neonatologists, and Pathologists have studied gross histological analysis of human placentas in search of specific alterations in placental functions that can be correlated with neonatal outcomes. Our study assessed the prevalence of abnormal placental findings associated with non-reassuring fetal monitoring in labor requiring emergent instrumental or cesarean delivery, followed by an excellent neonatal outcome. Study Design: One hundred consecutive emergency deliveries, instrumental or cesarean, performed due to non-reassuring fetal monitoring while in labor were retrospectively evaluated. All patients were low-risk for obstetric complications, and had a singleton, term pregnancy. They had a normal antenatal routine testing and a normal anatomy ultrasound scan at 20 to 22 weeks gestation. Results: There were 35 placentas (35%) with gross placental anomalies at the delivery triage. Additionally 7 placentas (7%) were reported to be abnormal at the pathology examination. Conclusion: The prevalence of abnormal placental findings in our studied population was 42%.

Admission Cardiotocography: Its Role in Predicting Perinatal Outcome in Term, Uncomplicated (Low Risk) Pregnant Women in Spontaneous Labour

Introduction: Labour admission cardiotocography (CTG) is commonly used non-invasive method of fetal monitoring in Sri Lanka. It may have a potentialto predict perinatal outcome in low-risk term pregnancies. Objectives: Objectives of the study were to determine the perinatal outcomes of normal, suspicious and pathological admission CTGs and role of labour admission cardiotocography as a predictive test for perinatal outcome in low-risk term pregnancies in spontaneous labour. Methods: This study was a prospective observational study done involving 445 low risk, term pregnancies in spontaneous labour. Labour admission CTG was performed in each pregnancy and categorized into normal, suspicious and pathological CTG according to criteria depicted by National Institute of Clinical Excellence (NICE) guideline 2007. Apgar score less than 7 at five minutes, resuscitation at birth, admission to neonatal intensive care unit (NICU), seizure within first 24 hours of birth and meconium-stained amniotic fluid were the primary outcome measures to assess fetal asphyxia. Mode of delivery in each category, nuchal cord at birth were also assessed. Results: Majority of participants were in 25-to-29-year age group and were nulliparous. Frequencies of normal, suspicious and pathological CTG were 74.8%, 18% and 7.2% respectively. Pathological CTG was significantly associated with low Apgar score compared to non-pathological CTG group (p 0.005) while other outcome measures were not significant. Rate of operative delivery was 68% in pathological group and 20.8% in non-pathological CTG group. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of labour admission CTG to detect fetal asphyxia were 51.85%, 95.69%, 43.75% and 96.85% respectively. Conclusions: Incidence of pathological labour admission CTG was 7.2%. Apgar score less than 7 at five minutes of birth was significantly associated with pathological CTG group compared to non-pathological CTG (p 0.05). Worsening of CTG from normal to pathological showed increasing rate of operative delivery. Even though sensitivity and positive predictive values of labour admission CTG were low, specificity and negative predictive values were high for detecting low Apgar score. Therefore, labour admission CTG has a value in excluding adverse perinatal outcomes in low-risk term pregnancies in spontaneous labour.

Ensemble Learning for Fetal Health Classification

Cardiotocography(CTG)represents the fetus’s health inside the womb during labor.However,assessment of its readings can be a highly subjective process depending on the expertise of the obstetrician.Digital signals from fetal monitors acquire parameters(i.e.,fetal heart rate,contractions,acceleration).Objective:This paper aims to classify the CTG readings containing imbalanced healthy,suspected,and pathological fetus readings.Method:We perform two sets of experiments.Firstly,we employ five classifiers:Random Forest(RF),Adaptive Boosting(AdaBoost),Categorical Boosting(CatBoost),Extreme Gradient Boosting(XGBoost),and Light Gradient Boosting Machine(LGBM)without over-sampling to classify CTG readings into three categories:healthy,suspected,and pathological.Secondly,we employ an ensemble of the above-described classifiers with the oversamplingmethod.We use a random over-sampling technique to balance CTG records to train the ensemble models.We use 3602 CTG readings to train the ensemble classifiers and 1201 records to evaluate them.The outcomes of these classifiers are then fed into the soft voting classifier to obtain the most accurate results.Results:Each classifier evaluates accuracy,Precision,Recall,F1-scores,and Area Under the Receiver Operating Curve(AUROC)values.Results reveal that the XGBoost,LGBM,and CatBoost classifiers yielded 99%accuracy.Conclusion:Using ensemble classifiers over a balanced CTG dataset improves the detection accuracy compared to the previous studies and our first experiment.A soft voting classifier then eliminates the weakness of one individual classifier to yield superior performance of the overall model.

产时胎儿电子监护图形与新生儿脐动脉血酸碱度的相关性研究

目的探讨胎儿电子监护图形评估胎儿酸碱失衡的临床价值。方法产程中胎儿电子监护图形异常的产妇82例,其中早期减速图形18例,晚期减速图形16例,轻度变异减速18例,重度变异减速15例,心动过缓15例。全产程胎儿监护图形均正常的40例产妇为对照组。各组胎儿娩出后立即检测脐动脉血酸碱度(p H)、剩余碱(BE)、标准碳酸氢盐(SB)、二氧化碳分压(PCO2)、氧分压(PO2)。结果与对照组比较,重度变异减速组、晚期减速组及胎儿心动过缓组p H、BE、SB、PO2均明显下降,PCO2明显升高(P<0.05)。早期减速组各指标值与对照组比较,差异均无统计学意义(P>0.05),与早期减速组比较,重度变异减速组、晚期减速组p H、BE、SB、PO2均明显下降,PCO2明显升高(P<0.05)。重度变异减速组、晚期减速组及胎儿心动过缓组的血气各指标值比较,差异均无统计学意义(P>0.05)。结论早期减速图形与酸中毒无关;轻度变异减速图形提示胎儿处于缺氧代偿期,但尚无酸中毒;晚期减速、重度变异减速及心动过缓提示胎儿酸中毒,一旦出现应该做好进一步评估,必要时及时终止妊娠。

胎心监护预测胎儿宫内窘迫

目的探讨胎心监护对胎儿宫内窘迫的预测价值。方法应用胎心监护仪对658例临产前和(或)临产后的孕妇进行胎心监护。结果NST(无负荷试验)有反应型(401例),发生胎儿窘迫2.49%,NST无反应型(28例),发生胎儿窘迫46.67%,P<0.01),有显著性差异。CST(宫缩刺激试验)阴性(171例),发生胎儿窘迫11.69%,CST阳性(23例),发生胎儿窘迫88.46%,(P<0.01),有明显的差异。结论NST和CST分别是产前和产时胎心监护的有效方法,可以作为预测胎儿宫内窘迫的筛选试验,其准确性、敏感性、阴性预测值、阳性预测值分别为91.11%、73.68%、97.51%、46.67%和88.32%、53.49%、88.31%、88.46%。

脐血乳酸水平、产时胎心监护不良图形和新生儿结局关系的研究

目的：研究脐动脉血乳酸水平与产时胎心监护不良图形及新生儿结局之间的关系。方法：229例足月妊娠、单胎、头位产妇根据产时胎心宫缩图（cardiotocography，CTG）分为两组，观察组：轻度变异减速（variable deceleration，VD）68例、不良CTG包括中、重度VD、不典型VD、胎心基线变异减弱或消失、延长减速、重度晚期减速及心动过缓84例。对照组：产时CTG无VD及不良图形、新生儿脐动脉血pH≥7．20的产妇77例，检测新生儿脐动脉血乳酸浓度及生后20项行为神经评分（neonatal behavioral neudogioal assessment，NBNA）。结果：对照组脐动脉血乳酸99％参考值范围为1．31～4．05mmol／L，不良CTG脐血乳酸水平明显高于对照组（P〈0．01）；pH、BE值显著低于对照组与轻度VD组（P〈0．01，P〈0．05），脐血乳酸水平与pH、BE呈显著负相关（P〈0．01）。以对照组面±2．58s为界值，观察组脐血乳酸超过界值者不良CTG占73．33％，其中不良结局儿占68．18％。结论：脐动脉乳酸水平与pH、BE值有较好的相关性。产时重度VD或VD并存其它异常CTG，胎心基线变异减弱，尤其伴发羊水粪染、脐带异常时与围生儿脐血高乳酸水平、不良结局有关。

第二产程胎心监护异常图形对妊娠结局的影响

目的：将第二产程胎心监护异常图形分为良好图形和不良图形，探讨其对产程处理的指导意义。方法：2004年1—8月间565例胎心监护图形（CTG）中的289例（51．2％）为异常图形，将289例异常图形分为良好图形155例（对照组），不良图形134例（观察组），对比两组图形对妊娠结局的影响。结果：观察组脐带绕颈（18．7％）明显高于对照组（5．2％），P〈0．05；阴道助产（11．2％）、剖宫产率（26．1％）明显高于对照组（3．2％、6．5％），P〈0．05、P〈0．01；Ⅱ°-Ⅲ°羊水粪染（13．4％）高于对照组（1．9％），P〈0．05；第二产程时限（35±21）min明显短于对照组（60±30）min，P〈0．01；新生儿窒息两组差异无显著性（4．5％、2．6％），P〉0．05。观察组异常图形为持续性心动过缓。频发VD及LD、PD，甚至出现基线变异减弱或消失；对照组为一过性心动过速，偶发ED、VD或LD、PD，无基线变异减弱或消失。结论：良好图形为一过性偶发的异常图形，不良图形为持续性、频发的异常图形；对良好图形密切观察，防止过早干预，对不良图形应积极处理，防止造成不良后果。

孕妇可穿戴设备的应用与管理

近年来,孕妇可穿戴设备产业发展迅速,从胎心监护仪到多功能检查仪,实现了胎心、血糖、血压等指标的院内外监测与管理。孕妇可穿戴设备正以一种前所未有的方式将医院和母胎联系在一起。本文介绍可穿戴设备及其关键技术,探讨面向妊娠期女性可穿戴设备的典型应用及医院产科的监护管理模式,并分析当前国内外孕妇可穿戴设备领域面临的问题和对策。

基于遗传算法和BP神经网络的CTG识别研究

目的:针对正常类、非典型类和异常类3类胎心宫缩监护图(Cardiotocography,CTG),利用BP神经网络建立分类识别模型。方法:根据遗传算法(Genetic algorithm,GA)具有全局寻优的特点,引入遗传算法对神经网络权值和阈值进行优化,形成一种训练神经网络的混合算法(GA-BP算法),以克服BP算法易陷入局部最优解的缺陷,并以UCI数据库中的CTG数据集为例进行测试。结论:仿真结果表明,对于正常类、非典型类和异常类3类样本,BP算法的分类准确率分别为97.32%、71.97%和95.45%,而GA-BP算法的分类准确率分别提高到98.24%、82.67%和95.65%。可见GA-BP分类模型具有较强的学习能力和泛化能力,分类准确度更令人满意,所提出的方法是可行的。

胎儿宫内窘迫行剖宫产术221例临床分析

目的探讨如何预防和早期发现胎儿窘迫,减少新生儿窒息,正确诊断,及时行剖宫产术。方法将该院以胎儿窘迫为第一手术指征行剖宫产的221例患者进行回顾性分析,以宫口开大情况分为未临产组、潜伏期组、活跃期组,分析各组胎儿窘迫的相关因素、新生儿Apgar评分情况。结果新生儿窒息率5.43%。胎儿窘迫发生在未临产组115例(52.04%),潜伏期组54例(24.43%),活跃期组52例(23.53%)。3组诊断符合率分别为77.39%、98.14%、98.08%。221例病例中早产33例,未临产组30例(90.91%)。结论加强产前、产时胎儿的胎心监护,早期发现胎儿受损迹象,及时进行干预,可以减少新生儿窒息发生率。

第二产程胎心监护对胎儿预后的预测价值

目的探讨第二产程胎心监护对胎儿酸血症的预测价值及各不良胎心宫缩图(CTG)图形与不同类型胎儿酸中毒的关系。方法以216例在第二产程具有满意胎心监护图形的产妇为研究对象。胎儿娩出后,立即做脐血血气分析,记录胎儿结局,并追踪新生儿病率情况。结果①第二产程正常、可疑及病理CTG图形预测胎儿酸血症的敏感性分别为3.57%、10.72%和85.71%,特异性为57.45%、61.70%和80.85%,阳性预测值为1.23%、4.00%和40.00%,阴性预测值为80.00%、82.27%和97.44%,准确度为50.46%、55.09和81.48%。②晚期减速、延长减速在代谢性酸血症组的发生率明显高于呼吸性酸血症组及混合性酸血症组(P值分别为0.001、0.027);重度VD、重度心动过缓在混合性酸血症组明显高于代谢性酸血症及呼吸性酸血症组(P值分别为0.041、0.004);融合减速在呼吸性酸血症组明显高于混合性酸血症及代谢性酸血症组(P=0.006);基线变异消失在三组间无统计学差异(P=0.168)。结论①第二产程单用胎心监护识别胎儿酸中毒的能力非常有限,需结合其它监护手段进行综合判断,以避免不必要的手术干预。②晚期减速(LD)、延长减速(PD)与代谢性酸中毒有关;重度变异减速(VD)、重度心动过缓与混合性酸中毒有关;融合减速与呼吸性酸中毒有关。

胎儿中央监护网络系统的临床应用评价

目的探讨中央胎心监护系统与胎儿窘迫及剖宫产之间的关系。方法对某院2006-07/2007-10月的1028例孕妇(监测组)进行中央胎心监护系统监护,并对2005-03/2006-06月进行常规多普勒听诊胎心的孕妇(对照组)进行比较,分析两组胎儿窘迫发生率、新生儿窒息率。结果监测组与对照组胎儿窘迫发生率分别为6.71%、10.36%;新生儿重度窒息发生率分别为0、0.9%;剖宫产率分别为4.96%、9.17%。结论使用中央胎心监护系统新生儿重度窒息发生率明显下降,剖宫产率并不增高。

延期妊娠联合监护改善围产儿预后的研究(附238例分析)

目的探讨胎儿电子监测与羊水指数(AFI)测定联合监护延期妊娠对改善围产儿预后的临床价值。方法对我院2002年1月至2004年12月收治的238例单胎延期妊娠孕妇的临床资料、产前AFI测定结果及胎儿电子监测结果与围产儿预后的关系进行回顾性分析。结果延期妊娠组孕妇AFI或胎心监护指标异常比例均高于正常孕妇组(P<0.01);AFI<8cm或胎儿电子监测异常者,其胎儿窘迫及低Apgar评分的发生率均高于AFI≥8cm和胎儿电子监测正常者(P<0.05或P<0.01);AFI及胎心监测两项指标均异常者胎儿窘迫及低Apgar评分发生率均高于单项指标异常组(P<0.05或P<0.01)。结论联合胎儿电子监测与羊水指数两项指标监护延期妊娠能提高对围产儿不良预后的预测。

胎心监护计算机自动分析系统的设计与应用

目的:为长治市妇幼保健院提供一种具有胎儿宫内状态自动评分功能的计算机辅助分析系统,提高胎心监护结果判读分析的准确度和一致性。方法:系统可以对当前胎监记录的任何一段数据进行分析,专业算法更准确地运算出胎心率基线、胎动、宫缩、各种胎心率加、减速等特征参数,使分析结果更趋准确。系统的评分方式支持自动、手动评分两种方式,包括了Krebis、Fischer、改良Fischer评分法和ACOG三级分类法。结果:通过在医院的临床试验,系统的分析和评分结果与产科专家人工判读结果具有较高的一致性。结论:计算机辅助分析为胎心监护分析提供一种额外的辅助方法,提高了妇产科医生的工作效率。

第二产程胎心监护异常图形对新生儿预后的影响

目的将第二产程胎心监护异常图形分为良好图形和不良图形,探讨其对产程处理的指导意义。方法2007年1-2008年1月1000例胎心监护图形（CTG）中的512例（51.2%）为异常图形,将512例异常图形分为良好图形315例（对照组）,不良图形197例（观察组）,对比两组图形对新生儿预后的影响。结果观察组脐带绕颈（18.7%）明显高于对照组（5.2%）,P〈0.05;阴道助产（11.2%）、剖宫产率（26.1%）明显高于对照组（3.2%、6.5%）,P〈0.05、P〈0.01;Ⅱ°-Ⅲ°羊水粪染（13.4%）高于对照组（1.9%）,P〈0.05;第二产程时限（35±21）min明显短于对照组（60±30）min,P〈0.01;新生儿窒息两组差异无显著性（4.5%、2.6%）,P〉0.05。观察组异常图形为持续性心动过缓,频发VD及LD、PD,甚至出现基线变异减弱或消失;对照组为一过性心动过速,偶发ED、VD或LD、PD,无基线变异减弱或消失。结论良好图形为一过性偶发的异常图形,不良图形为持续性、频发的异常图形;对良好图形密切观察,防止过早干预,对不良图形应积极处理,防止造成不良后果。

产时彩超脐动脉S/D值监测联合胎心监护在诊断胎儿窘迫中的研究

目的研究当CTG正常及出现各种胎儿窘迫波形时脐动脉血流变化情况;分析各组中脐动脉最大最小血流速度之比(S/D)值与胎儿窘迫的关系;评价两种方法联合应用对胎儿窘迫的诊断有何益处。方法选择足月临床孕妇300例,在产时行CTG,其中胎心监护出现异常者,分为晚期减速组(1ate deceleration group,LD组)35例及重度变异减速组(severe variable deceleration group,SVD组)47例,对两组的孕妇分别行产时彩色多普勒脐动脉血流分析,测量其宫缩期及间歇期的最小血流速度(MIN)、最大血流速度(MAX)、S/D、阻力指数(最大最小速度差与最大速度之比,RI),产后观察有无胎儿窘迫,并比较单独使用CTG或S/D值及联合使用两种方法预测胎儿窘迫的敏感性、特异性、阳性预测值,阴性预测值。结果正常组与SVD组、LD组(35例)两组分别比较MIN、S/D和RI之间均有差异;正常组与SVD组、LD组分别比较,SVD组与LD组两组比较,胎儿窘迫的发生率有统计学差异;宫缩间歇期脐动脉S/D值对胎儿窘迫的预测的特异性较高,而其敏感性较低,CTG联合S/D对胎儿窘迫的预测的特异性和敏感性无明显提高;但CTG联合S/D可提高对胎儿窘迫的阳性预测值。结论单纯应用产时脐动脉S/D值筛查胎儿窘迫有较大缺陷,但CTG联合S/D可降低CTG的假阳性,减少不必要的剖宫产,是胎儿窘迫诊断的有益补充。