Zastosowanie rozmytych reguł wnioskowania do automatycznej klasyfikacji zapisów częstości uderzeń serca płodu w odniesieniu do stanu urodzeniowego

Objectives: Fetal monitoring based on the analysis of the fetal heart rate (FHR) signal is the most common method of biophysical assessment of fetal condition during pregnancy and labor. Visual analysis of FHR signals presents a challenge due to a complex shape of the waveforms. Therefore, computer-aided fetal monitoring systems provide a number of parameters that are the result of the quantitative analysis of the registered signals. These parameters are the basis for a qualitative assessment of the fetal condition. The guidelines for the interpretation of FHR provided by FIGO are commonly used in clinical practice. On their basis a weighted fuzzy scoring system was constructed to assess the FHR tracings using the same criteria as those applied by expert clinicians. The effectiveness of the automated classification was evaluated in relation to the fetal outcome assessed by Apgar score. Material and methods: The proposed automated system for fuzzy classification is an extension of the scoring systems used for qualitative evaluation of the FHR tracings. A single fuzzy rule of the system corresponds to a single evaluation principle of a signal parameter derived from the FIGO guidelines. The inputs of the fuzzy system are the values of quantitative parameters of the FHR signal, whereas the system output, which is calculated in the process of fuzzy inference, defines the interpretation of the FHR tracing. The fuzzy evaluation process is a kind of diagnostic test, giving a negative or a positive result that can be compared with the fetal outcome assessment. The present retrospective study included a set of 2124 one-hour antenatal FHR tracings derived from 333 patients, recorded between 24 and 44 weeks of gestation (mean gestational age: 36 weeks). Various approaches for the research data analysis, depending on the method of interpretation of the individual patient-tracing relation, were used in the investigation. The quality of the fuzzy analysis was defined by the number of correct classifications (CC) and the additional index QI – the geometric mean of the sensitivity and specificity values. Results: The effectiveness of the fetal assessment varied, depending on the assumed relation between a patient and a set of her tracings. The approach, based on a common assessment of the whole set of tracings recorded for a single patient, provided the highest quality of automated classification. The best results (CC = 70.9% and QI = 84.0%) confirmed the possibility of predicting the neonatal outcome using the proposed fuzzy system based on the FIGO guidelines. Conclusions: It is possible to enhance the process of the fetal condition assessment with classification of the FHR records through the implementation of the heuristic rules of inference in the fuzzy signal processing algorithms.Cel pracy: Monitorowanie płodu na podstawie analizy sygnału czynności serca płodu (FHR) jest najczęściej stosowaną metodą biofizycznej oceny stanu płodu w czasie ciąży i porodu. Wzrokowa analiza krzywej FHR jest trudna z uwagi na jej złożony kształt. Z tego względu, komputerowo-wspomagane systemy monitorowania stanu płodu dostarczają szeregu parametrów będących rezultatem ilościowej analizy rejestrowanego sygnału. Parametry te są podstawą dla jakościowej oceny stanu płodu. Do najczęściej stosowanych wytycznych, określających sposób interpretacji sygnału FHR należą kryteria określone przez FIGO. Na ich podstawie skonstruowano ważony rozmyty system punktowy, którego zadaniem jest określenie stanu płodu na podstawie kryteriów oceny, jakimi posługuje się ekspert kliniczny. W pracy przedstawiono badania nad zgodnością rozmytej klasyfikacji z oceną stanu płodu wyznaczaną na podstawie punktacji Apgar. Materiał i metody: Proponowany system do automatycznej, rozmytej klasyfikacji stanowi rozwinięcie idei skal punktowych wykorzystywanych do jakościowej oceny zapisów czynności serca płodu. Za pomocą jednej reguły rozmytej modelowana jest zasada oceny pojedynczego parametru opisu ilościowego sygnału FHR zgodnie z wytycznymi FIGO. Wejściami systemu rozmytego są wartości parametrów ilościowych sygnału FHR, a stan wyjścia, wyznaczany w procesie wnioskowania rozmytego, definiuje interpretację zapisu. Proces rozmytej oceny sygnału jest rodzajem testu diagnostycznego, którego wynik, negatywny lub pozytywny, można porównać z oceną stanu urodzeniowego noworodka. Badaniem retrospektywnym objęto zbiór 2124 godzinnych zapisów ciążowych pochodzących od 333 pacjentek, zarejestrowanych pomiędzy 24 a 44 tygodniem ciąży (średni wiek ciążowy to 36 tygodni). W eksperymentach zastosowano różne konstrukcje zbiorów danych, w zależności od przyjętego sposobu interpretacji zbioru sygnałów zarejestrowanych dla pojedynczej pacjentki. Jakość rozmytej analizy automatycznej oceniano na podstawie liczby poprawnych klasyfikacji CC oraz wskaźnika QI będącego średnią geometryczną czułości oraz swoistości. Wyniki: W zależności od przyjętej metody analizy zbioru danych otrzymano różną skuteczność oceny stanu płodu. Podejście, w którym określano jedną wspólną ocenę dla całego zbioru zapisów zarejestrowanych dla pojedynczej pacjentki, pozwoliło na uzyskanie najwyższej jakości automatycznej klasyfikacji. Najlepsze z uzyskanych wyników (CC = 70.9% i QI = 84.0%) potwierdzają możliwość predykcji stanu urodzeniowego płodu na podstawie rozmytego wnioskowania opartego na wytycznych FIGO. Wnioski: Istnieje możliwość wspomagania procesu diagnostyki stanu płodu przez zastosowanie systemu rozmytej klasyfikacji sygnałów FHR, opartego o heurystyczne reguły wnioskowania właściwe doświadczonemu klinicyście

Antepartum fetal heart rate feature extraction and classification using empirical mode decomposition and support vector machine

<p>Abstract</p> <p>Background</p> <p>Cardiotocography (CTG) is the most widely used tool for fetal surveillance. The visual analysis of fetal heart rate (FHR) traces largely depends on the expertise and experience of the clinician involved. Several approaches have been proposed for the effective interpretation of FHR. In this paper, a new approach for FHR feature extraction based on empirical mode decomposition (EMD) is proposed, which was used along with support vector machine (SVM) for the classification of FHR recordings as 'normal' or 'at risk'.</p> <p>Methods</p> <p>The FHR were recorded from 15 subjects at a sampling rate of 4 Hz and a dataset consisting of 90 randomly selected records of 20 minutes duration was formed from these. All records were labelled as 'normal' or 'at risk' by two experienced obstetricians. A training set was formed by 60 records, the remaining 30 left as the testing set. The standard deviations of the EMD components are input as features to a support vector machine (SVM) to classify FHR samples.</p> <p>Results</p> <p>For the training set, a five-fold cross validation test resulted in an accuracy of 86% whereas the overall geometric mean of sensitivity and specificity was 94.8%. The Kappa value for the training set was .923. Application of the proposed method to the testing set (30 records) resulted in a geometric mean of 81.5%. The Kappa value for the testing set was .684.</p> <p>Conclusions</p> <p>Based on the overall performance of the system it can be stated that the proposed methodology is a promising new approach for the feature extraction and classification of FHR signals.</p

Machine learning and disease prediction in obstetrics

Machine learning technologies and translation of artificial intelligence tools to enhance the patient experience are changing obstetric and maternity care. An increasing number of predictive tools have been developed with data sourced from electronic health records, diagnostic imaging and digital devices. In this review, we explore the latest tools of machine learning, the algorithms to establish prediction models and the challenges to assess fetal well-being, predict and diagnose obstetric diseases such as gestational diabetes, pre-eclampsia, preterm birth and fetal growth restriction. We discuss the rapid growth of machine learning approaches and intelligent tools for automated diagnostic imaging of fetal anomalies and to asses fetoplacental and cervix function using ultrasound and magnetic resonance imaging. In prenatal diagnosis, we discuss intelligent tools for magnetic resonance imaging sequencing of the fetus, placenta and cervix to reduce the risk of preterm birth. Finally, the use of machine learning to improve safety standards in intrapartum care and early detection of complications will be discussed. The demand for technologies to enhance diagnosis and treatment in obstetrics and maternity should improve frameworks for patient safety and enhance clinical practice

A Comprehensive Review of Techniques for Processing and Analyzing Fetal Heart Rate Signals

The availability of standardized guidelines regarding the use of electronic fetal monitoring (EFM) in clinical practice has not effectively helped to solve the main drawbacks of fetal heart rate (FHR) surveillance methodology, which still presents inter- and intra-observer variability as well as uncertainty in the classification of unreassuring or risky FHR recordings. Given the clinical relevance of the interpretation of FHR traces as well as the role of FHR as a marker of fetal wellbeing autonomous nervous system development, many different approaches for computerized processing and analysis of FHR patterns have been proposed in the literature. The objective of this review is to describe the techniques, methodologies, and algorithms proposed in this field so far, reporting their main achievements and discussing the value they brought to the scientific and clinical community. The review explores the following two main approaches to the processing and analysis of FHR signals: traditional (or linear) methodologies, namely, time and frequency domain analysis, and less conventional (or nonlinear) techniques. In this scenario, the emerging role and the opportunities offered by Artificial Intelligence tools, representing the future direction of EFM, are also discussed with a specific focus on the use of Artificial Neural Networks, whose application to the analysis of accelerations in FHR signals is also examined in a case study conducted by the authors

The Significance of Machine Learning in Clinical Disease Diagnosis: A Review

The global need for effective disease diagnosis remains substantial, given the complexities of various disease mechanisms and diverse patient symptoms. To tackle these challenges, researchers, physicians, and patients are turning to machine learning (ML), an artificial intelligence (AI) discipline, to develop solutions. By leveraging sophisticated ML and AI methods, healthcare stakeholders gain enhanced diagnostic and treatment capabilities. However, there is a scarcity of research focused on ML algorithms for enhancing the accuracy and computational efficiency. This research investigates the capacity of machine learning algorithms to improve the transmission of heart rate data in time series healthcare metrics, concentrating particularly on optimizing accuracy and efficiency. By exploring various ML algorithms used in healthcare applications, the review presents the latest trends and approaches in ML-based disease diagnosis (MLBDD). The factors under consideration include the algorithm utilized, the types of diseases targeted, the data types employed, the applications, and the evaluation metrics. This review aims to shed light on the prospects of ML in healthcare, particularly in disease diagnosis. By analyzing the current literature, the study provides insights into state-of-the-art methodologies and their performance metrics.Comment: 8 page

A deep learning mixed-data type approach for the classification of FHR signals

The Cardiotocography (CTG) is a widely diffused monitoring practice, used in Ob-Gyn Clinic to assess the fetal well-being through the analysis of the Fetal Heart Rate (FHR) and the Uterine contraction signals. Due to the complex dynamics regulating the Fetal Heart Rate, a reliable visual interpretation of the signal is almost impossible and results in significant subjective inter and intra-observer variability. Also, the introduction of few parameters obtained from computer analysis did not solve the problem of a robust antenatal diagnosis. Hence, during the last decade, computer aided diagnosis systems, based on artificial intelligence (AI) machine learning techniques have been developed to assist medical decisions. The present work proposes a hybrid approach based on a neural architecture that receives heterogeneous data in input (a set of quantitative parameters and images) for classifying healthy and pathological fetuses. The quantitative regressors, which are known to represent different aspects of the correct development of the fetus, and thus are related to the fetal healthy status, are combined with features implicitly extracted from various representations of the FHR signal (images), in order to improve the classification performance. This is achieved by setting a neural model with two connected branches, consisting respectively of a Multi-Layer Perceptron (MLP) and a Convolutional Neural Network (CNN). The neural architecture was trained on a huge and balanced set of clinical data (14.000 CTG tracings, 7000 healthy and 7000 pathological) recorded during ambulatory non stress tests at the University Hospital Federico II, Napoli, Italy. After hyperparameters tuning and training, the neural network proposed has reached an overall accuracy of 80.1%, which is a promising result, as it has been obtained on a huge dataset

Contributions to evaluation of machine learning models. Applicability domain of classification models

Artificial intelligence (AI) and machine learning (ML) present some application opportunities and challenges that can be framed as learning problems. The performance of machine learning models depends on algorithms and the data. Moreover, learning algorithms create a model of reality through learning and testing with data processes, and their performance shows an agreement degree of their assumed model with reality. ML algorithms have been successfully used in numerous classification problems. With the developing popularity of using ML models for many purposes in different domains, the validation of such predictive models is currently required more formally. Traditionally, there are many studies related to model evaluation, robustness, reliability, and the quality of the data and the data-driven models. However, those studies do not consider the concept of the applicability domain (AD) yet. The issue is that the AD is not often well defined, or it is not defined at all in many fields. This work investigates the robustness of ML classification models from the applicability domain perspective. A standard definition of applicability domain regards the spaces in which the model provides results with specific reliability. The main aim of this study is to investigate the connection between the applicability domain approach and the classification model performance. We are examining the usefulness of assessing the AD for the classification model, i.e. reliability, reuse, robustness of classifiers. The work is implemented using three approaches, and these approaches are conducted in three various attempts: firstly, assessing the applicability domain for the classification model; secondly, investigating the robustness of the classification model based on the applicability domain approach; thirdly, selecting an optimal model using Pareto optimality. The experiments in this work are illustrated by considering different machine learning algorithms for binary and multi-class classifications for healthcare datasets from public benchmark data repositories. In the first approach, the decision trees algorithm (DT) is used for the classification of data in the classification stage. The feature selection method is applied to choose features for classification. The obtained classifiers are used in the third approach for selection of models using Pareto optimality. The second approach is implemented using three steps; namely, building classification model; generating synthetic data; and evaluating the obtained results. The results obtained from the study provide an understanding of how the proposed approach can help to define the model’s robustness and the applicability domain, for providing reliable outputs. These approaches open opportunities for classification data and model management. The proposed algorithms are implemented through a set of experiments on classification accuracy of instances, which fall in the domain of the model. For the first approach, by considering all the features, the highest accuracy obtained is 0.98, with thresholds average of 0.34 for Breast cancer dataset. After applying recursive feature elimination (RFE) method, the accuracy is 0.96% with 0.27 thresholds average. For the robustness of the classification model based on the applicability domain approach, the minimum accuracy is 0.62% for Indian Liver Patient data at r=0.10, and the maximum accuracy is 0.99% for Thyroid dataset at r=0.10. For the selection of an optimal model using Pareto optimality, the optimally selected classifier gives the accuracy of 0.94% with 0.35 thresholds average. This research investigates critical aspects of the applicability domain as related to the robustness of classification ML algorithms. However, the performance of machine learning techniques depends on the degree of reliable predictions of the model. In the literature, the robustness of the ML model can be defined as the ability of the model to provide the testing error close to the training error. Moreover, the properties can describe the stability of the model performance when being tested on the new datasets. Concluding, this thesis introduced the concept of applicability domain for classifiers and tested the use of this concept with some case studies on health-related public benchmark datasets.Ministry of Higher Education in Liby

Predicting complex system behavior using hybrid modeling and computational intelligence

“Modeling and prediction of complex systems is a challenging problem due to the sub-system interactions and dependencies. This research examines combining various computational intelligence algorithms and modeling techniques to provide insights into these complex processes and allow for better decision making. This hybrid methodology provided additional capabilities to analyze and predict the overall system behavior where a single model cannot be used to understand the complex problem. The systems analyzed here are flooding events and fetal health care. The impact of floods on road infrastructure is investigated using graph theory, agent-based traffic simulation, and Long Short-Term Memory deep learning to predict water level rise from river gauge height. Combined with existing infrastructure models, these techniques provide a 15-minute interval for making closure decisions rather than the current 6-hour interval. The second system explored is fetal monitoring, which is essential to diagnose severe fetal conditions such as acidosis. Support Vector Machine and Random Forest were compared to identify the best model for classification of fetal state. This model provided a more accurate classification than existing research on the CTG. A deep learning forecasting model was developed to predict the future values for fetal heart rate and uterine contractions. The forecasting and classification algorithms are then integrated to evaluate the future condition of the fetus. The final model can predict the fetal state 4 minutes ahead to help the obstetricians to plan necessary interventions for preventing acidosis and asphyxiation. In both cases, time series predictions using hybrid modeling provided superior results to existing methods to predict complex behaviors”--Abstract, page iv

Computational intelligence methods for predicting fetal outcomes from heart rate patterns

In this thesis, methods for evaluating the fetal state are compared to make predictions based on Cardiotocography (CTG) data. The first part of this research is the development of an algorithm to extract features from the CTG data. A feature extraction algorithm is presented that is capable of extracting most of the features in the SISPORTO software package as well as late and variable decelerations. The resulting features are used for classification based on both U.S. National Institutes of Health (NIH) categories and umbilical cord pH data. The first experiment uses the features to classify the results into three different categories suggested by the NIH and commonly being used in practice in hospitals across the United States. In addition, the algorithms developed here were used to predict cord pH levels, the actual condition that the three NIH categories are used to attempt to measure. This thesis demonstrates the importance of machine learning in Maternal and Fetal Medicine. It provides assistance for the obstetricians in assessing the state of the fetus better than the category methods, as only about 30% of the patients in the Pathological category suffer from acidosis, while the majority of acidotic babies were in the suspect category, which is considered lower risk. By predicting the direct indicator of acidosis, umbilical cord pH, this work demonstrates a methodology to achieve a more accurate prediction of fetal outcomes using Fetal Heartrate and Uterine Activity with accuracies of greater than 99.5% for predicting categories and greater than 70% for fetal acidosis based on pH values --Abstract, page iii

Machine learning algorithms combining slope deceleration and fetal heart rate features to predict acidemia

Electronic fetal monitoring (EFM) is widely used in intrapartum care as the standard method for monitoring fetal well-being. Our objective was to employ machine learning algorithms to predict acidemia by analyzing specific features extracted from the fetal heart signal within a 30 min window, with a focus on the last deceleration occurring closest to delivery. To achieve this, we conducted a case–control study involving 502 infants born at Miguel Servet University Hospital in Spain, maintaining a 1:1 ratio between cases and controls. Neonatal acidemia was defined as a pH level below 7.10 in the umbilical arterial blood. We constructed logistic regression, classification trees, random forest, and neural network models by combining EFM features to predict acidemia. Model validation included assessments of discrimination, calibration, and clinical utility. Our findings revealed that the random forest model achieved the highest area under the receiver characteristic curve (AUC) of 0.971, but logistic regression had the best specificity, 0.879, for a sensitivity of 0.95. In terms of clinical utility, implementing a cutoff point of 31% in the logistic regression model would prevent unnecessary cesarean sections in 51% of cases while missing only 5% of acidotic cases. By combining the extracted variables from EFM recordings, we provide a practical tool to assist in avoiding unnecessary cesarean sections