An Improved Model Ensembled of Different Hyper-parameter Tuned Machine Learning Algorithms for Fetal Health Prediction

Fetal health is a critical concern during pregnancy as it can impact the well-being of both the mother and the baby. Regular monitoring and timely interventions are necessary to ensure the best possible outcomes. While there are various methods to monitor fetal health in the mother's womb, the use of artificial intelligence (AI) can improve the accuracy, efficiency, and speed of diagnosis. In this study, we propose a robust ensemble model called ensemble of tuned Support Vector Machine and ExtraTrees (ETSE) for predicting fetal health. Initially, we employed various data preprocessing techniques such as outlier rejection, missing value imputation, data standardization, and data sampling. Then, seven machine learning (ML) classifiers including Support Vector Machine (SVM), XGBoost (XGB), Light Gradient Boosting Machine (LGBM), Decision Tree (DT), Random Forest (RF), ExtraTrees (ET), and K-Neighbors were implemented. These models were evaluated and then optimized by hyperparameter tuning using the grid search technique. Finally, we analyzed the performance of our proposed ETSE model. The performance analysis of each model revealed that our proposed ETSE model outperformed the other models with 100% precision, 100% recall, 100% F1-score, and 99.66% accuracy. This indicates that the ETSE model can effectively predict fetal health, which can aid in timely interventions and improve outcomes for both the mother and the baby.Comment: 23 pages, 6 Tables, 5 Figure

Case based reasoning applied to medical diagnosis using multi-class classifier: A preliminary study

Case-based reasoning (CBR) is a process used for computer processing that tries to mimic the behavior of a human expert in making decisions regarding a subject and learn from the experience of past cases. CBR has demonstrated to be appropriate for working with unstructured domains data or difficult knowledge acquisition situations, such as medical diagnosis, where it is possible to identify diseases such as: cancer diagnosis, epilepsy prediction and appendicitis diagnosis. Some of the trends that may be developed for CBR in the health science are oriented to reduce the number of features in highly dimensional data. An important contribution may be the estimation of probabilities of belonging to each class for new cases. In this paper, in order to adequately represent the database and to avoid the inconveniences caused by the high dimensionality, noise and redundancy, a number of algorithms are used in the preprocessing stage for performing both variable selection and dimension reduction procedures. Also, a comparison of the performance of some representative multi-class classifiers is carried out to identify the most effective one to include within a CBR scheme. Particularly, four classification techniques and two reduction techniques are employed to make a comparative study of multiclass classifiers on CB

Cardiotocography Signal Abnormality Detection based on Deep Unsupervised Models

Cardiotocography (CTG) is a key element when it comes to monitoring fetal well-being. Obstetricians use it to observe the fetal heart rate (FHR) and the uterine contraction (UC). The goal is to determine how the fetus reacts to the contraction and whether it is receiving adequate oxygen. If a problem occurs, the physician can then respond with an intervention. Unfortunately, the interpretation of CTGs is highly subjective and there is a low inter- and intra-observer agreement rate among practitioners. This can lead to unnecessary medical intervention that represents a risk for both the mother and the fetus. Recently, computer-assisted diagnosis techniques, especially based on artificial intelligence models (mostly supervised), have been proposed in the literature. But, many of these models lack generalization to unseen/test data samples due to overfitting. Moreover, the unsupervised models were applied to a very small portion of the CTG samples where the normal and abnormal classes are highly separable. In this work, deep unsupervised learning approaches, trained in a semi-supervised manner, are proposed for anomaly detection in CTG signals. The GANomaly framework, modified to capture the underlying distribution of data samples, is used as our main model and is applied to the CTU-UHB dataset. Unlike the recent studies, all the CTG data samples, without any specific preferences, are used in our work. The experimental results show that our modified GANomaly model outperforms state-of-the-arts. This study admit the superiority of the deep unsupervised models over the supervised ones in CTG abnormality detection

Multimodal Convolutional Neural Networks to Detect Fetal Compromise During Labor and Delivery

The gold standard to assess whether a baby is at risk of oxygen deprivation during childbirth, is monitoring continuously the fetal heart rate with cardiotocography (CTG). The aim is to identify babies that could benefit from an emergency operative delivery (e.g., Cesarean section), in order to prevent death or permanent brain injury. The long, dynamic and complex CTG patterns are poorly understood and known to have high false positive and false negative rates. Visual interpretation by clinicians is challenging and reliable accurate fetal monitoring in labor remains an enormous unmet medical need. In this work, we applied deep learning methods to achieve data-driven automated CTG evaluation. Multimodal Convolutional Neural Network (MCNN) and Stacked MCNN models were used to analyze the largest available database of routinely collected CTG and linked clinical data (comprising more than 35000 births). We also assessed in detail the impact of the signal quality on the MCNN performance. On a large hold-out testing set from Oxford (n= 4429 births), MCNN improved the prediction of cord acidemia at birth when compared with Clinical Practice and previous computerized approaches. On two external datasets, MCNN demonstrated better performance compared to current feature extraction-based methods. Our group is the first to apply deep learning for the analysis of CTG. We conclude that MCNN hold potential for the prediction of cord acidemia at birth and further work is warranted. Despite the advances, our deep learning models are currently not suitable for the detection of severe fetal injury in the absence of cord acidemia - a heterogeneous, small, and poorly understood group. We suggest that the most promising way forward are hybrid approaches to CTG interpretation in labor, in which different diagnostic models can estimate the risk for different types of fetal compromise, incorporating clinical knowledge with data-driven analyses

Case based reasoning applied to medical diagnosis using multi-class classifier: A preliminary study

Case-based reasoning (CBR) is a process used for computer processing that tries to mimic the behavior of a human expert in making decisions regarding a subject and learn from the experience of past cases. CBR has demonstrated to be appropriate for working with unstructured domains data or difficult knowledge acquisition situations, such as medical diagnosis, where it is possible to identify diseases such as: cancer diagnosis, epilepsy prediction and appendicitis diagnosis. Some of the trends that may be developed for CBR in the health science are oriented to reduce the number of features in highly dimensional data. An important contribution may be the estimation of probabilities of belonging to each class for new cases. In this paper, in order to adequately represent the database and to avoid the inconveniences caused by the high dimensionality, noise and redundancy, a number of algorithms are used in the preprocessing stage for performing both variable selection and dimension reduction procedures. Also, a comparison of the performance of some representative multi-class classifiers is carried out to identify the most effective one to include within a CBR scheme. Particularly, four classification techniques and two reduction techniques are employed to make a comparative study of multiclass classifiers on CB

THE INFLUENCE OF CARDIOTOCOGRAM SIGNAL FEATURE SELECTION METHOD ON FETAL STATE ASSESSMENT EFFICACY

Cardiotocographic (CTG) monitoring is a method of assessing fetal state. Since visual analysis of CTG signal is difficult, methods of automated qualitative fetal state evaluation on the basis of the quantitative description of the signal are applied. The appropriate selection of learning data influences the quality of the fetal state assessment with computational intelligence methods. In the presented work we examined three different feature selection procedures based on: principal components analysis, receiver operating characteristics and guidelines of International Federation of Gynecology and Obstetrics. To investigate their influence on the fetal state assessment quality the benchmark SisPorto dataset and the Lagrangian support vector machine were used

Intelligent Pattern Analysis of the Foetal Electrocardiogram

The aim of the project on which this thesis is based is to develop reliable techniques for foetal electrocardiogram (ECG) based monitoring, to reduce incidents of unnecessary medical intervention and foetal injury during labour. World-wide electronic foetal monitoring is based almost entirely on the cardiotocogram (CTG), which is a continuous display of the foetal heart rate (FHR) pattern together with the contraction of the womb. Despite the widespread use of the CTG, there is no significant improvement in foetal outcome. In the UK alone it is estimated that birth related negligence claims cost the health authorities over £400M per-annum. An expert system, known as INFANT, has recently been developed to assist CTG interpretation. However, the CTG alone does not always provide all the information required to improve the outcome of labour. The widespread use of ECG analysis has been hindered by the difficulties with poor signal quality and the difficulties in applying the specialised knowledge required for interpreting ECG patterns, in association with other events in labour, in an objective way. A fundamental investigation and development of optimal signal enhancement techniques that maximise the available information in the ECG signal, along with different techniques for detecting individual waveforms from poor quality signals, has been carried out. To automate the visual interpretation of the ECG waveform, novel techniques have been developed that allow reliable extraction of key features and hence allow a detailed ECG waveform analysis. Fuzzy logic is used to automatically classify the ECG waveform shape using these features by using knowledge that was elicited from expert sources and derived from example data. This allows the subtle changes in the ECG waveform to be automatically detected in relation to other events in labour, and thus improve the clinicians position for making an accurate diagnosis. To ensure the interpretation is based on reliable information and takes place in the proper context, a new and sensitive index for assessing the quality of the ECG has been developed. New techniques to capture, for the first time in machine form, the clinical expertise / guidelines for electronic foetal monitoring have been developed based on fuzzy logic and finite state machines, The software model provides a flexible framework to further develop and optimise rules for ECG pattern analysis. The signal enhancement, QRS detection and pattern recognition of important ECG waveform shapes have had extensive testing and results are presented. Results show that no significant loss of information is incurred as a result of the signal enhancement and feature extraction techniques

A study of an intelligent system to support decision making in the management of labour using the cardiotocograph - the INFANT study protocol

Background Continuous electronic fetal heart rate monitoring in labour is widely used but its potential for improving fetal and neonatal outcomes has not been realised. The most likely reason is the difficulty of interpreting the fetal heart rate trace correctly during labour. Computerised interpretation of the fetal heart rate and intelligent decision-support has the potential to deliver this improvement in care. This trial will test whether the addition of decision support software to aid the interpretation of the cardiotocogram (CTG) during labour will reduce the number of ‘poor neonatal outcomes’ in those women judged to require continuous electronic fetal heart rate monitoring. Methods and design An individually randomised controlled trial of 46,000 women who are judged to require continuous electronic fetal monitoring in labour. Eligibility criteria: Women admitted to a participating labour ward who are judged to require continuous electronic fetal monitoring, have a singleton or twin pregnancy, are ≥ 35 weeks’ gestation, have no known gross fetal abnormality and are ≥ 16 years of age. Exclusion criteria: Triplets or higher order pregnancy, elective caesarean section prior to the onset of labour, planned admission to NICU. Trial interventions: Computerised interpretation of the CTG with decision-support. Primary outcomes: Short term: A composite of ‘poor neonatal outcome’ including stillbirth after trial entry, early neonatal death except deaths due to congenital anomalies, significant morbidity: neonatal encephalopathy, admissions to the neonatal unit with 48 h for > 48 h with evidence of feeding difficulties, respiratory illness or encephalopathy where there is evidence of compromise at birth. Long term: Developmental assessment at the age of 2 years in a subset of 7000 surviving babies. Data Collection: For all participating women and babies, labour variables and outcomes will be stored automatically and contemporaneously onto the Guardian® system. Discussion The results of this trial will have importance for pregnant women and for health professionals who provide care for them