Classification of Foetal Distress and Hypoxia Using Machine Learning Approaches

© 2018, Springer International Publishing AG, part of Springer Nature. Foetal distress and hypoxia (oxygen deprivation) is considered as a serious condition and one of the main factors for caesarean section in the obstetrics and Gynecology department. It is the third most common cause of death in new-born babies. Many foetuses that experienced some sort of hypoxic effects can develop series risks including damage to the cells of the central nervous system that may lead to life-long disability (cerebral palsy) or even death. Continuous labour monitoring is essential to observe the foetal well being. Foetal surveillance by monitoring the foetal heart rate with a cardiotocography is widely used. Despite the indication of normal results, these results are not reassuring, and a small proportion of these foetuses are actually hypoxic. In this paper, machine-learning algorithms are utilized to classify foetuses which are experiencing oxygen deprivation using PH value (a measure of hydrogen ion concentration of blood used to specify the acidity or alkalinity) and Base Deficit of extra cellular fluid level (a measure of the total concentration of blood buffer base that indicates the metabolic acidosis or compensated respiratory alkalosis) as indicators of respiratory and metabolic acidosis, respectively, using open source partum clinical data obtained from Physionet. Six well know machine learning classifier models are utilised in our experiments for the evaluation; each model was presented with a set of selected features derived from the clinical data. Classifier’s evaluation is performed using the receiver operating characteristic curve analysis, area under the curve plots, as well as the confusion matrix. Our simulation results indicate that machine-learning algorithms provide viable methods that could delivery improvements over conventional analysis

Fatores de risco maternos associados à acidose fetal Maternal risk factors associated with fetal acidosis

OBJETIVOS: avaliar os fatores de risco maternos associados à acidose fetal. MÉTODOS: estudo tipo caso-controle composto por 188 recém-nascidos, sendo que 47 compuseram o grupo casos (pH de artéria umbilical <7,0) e 141 os de controles (pH de artéria umbilical <7,1 <7,3) nascidos imediatamente após cada caso. Consideraram-se fatores de inclusão: recém-nascidos de gestações únicas e sem malformação congênita. Analisaram-se variáveis maternas e fetais. Foram realizadas a Odds Ratio bruta e ajustada, teste t de Student, teste do qui-quadrado e análise multivariada através da regressão logística nãocondicional pelo método Enter. Assumiu-se como nível de significância estatística um p<0,05. RESULTADOS: no grupo de casos foi observado maior percentual de cesarianas, de recém-nascidos pré-termo, que apresentaram quase cinco vezes mais necessidade de cuidados intensivos e vinte cinco vezes mais chance de Apgar no 5º minuto <7. Não foram observadas associação entre os grupos e a apresentação fetal, idade materna, história de abortos anteriores, escolaridade materna e frequência ao pré-natal. Após a análise multivariada persistiram como fator de risco complicações relacionadas com a placenta e cordão. Os recémnascidos cujos partos associaram-se a complicações da placenta ou do cordão umbilical apresentaram três vezes mais chance de acidemia fetal. CONCLUSÕES: os recém-nascidos acidóticos estiveram relacionados à maior percentual de cesarianas, de prematuridade, necessidade de cuidados de tratamento intensivo e índice de Apgar <7 no 5º minuto. Após a análise multivariada, persistiram como fator de risco para acidemia fetal as complicações relacionadas ao descolamento prematuro de placenta e cordão umbilical.<br>OBJECTIVES: to assess maternal risk factors associated with fetal acidosis. METHODS: a case-control type study was conducted of 188 neonates, of whom 47 comprised the case group (umbilical arterial pH <7.0) and 141 the control (umbilical arterial pH E7.1 <7.3). The study included only single-gestation neonates without congenital malformations. Both maternal and fetal variables were taken into consideration. Statistical analysis involved the calculation of the raw and adjusted Odds Ratio, Student's t-test, the chi-squared test and multivariate analysis using Enter-method non-conditional logistic regression. The level of statistical significance was set at p<0.05. RESULTS: in the case group higher percentages of caesarian sections and pre-term births were observed, involving almost five times as much intensive care and twenty-five times more likelihood of Apgar in the 5th minute <7. No association was observed between the groups and fetal presentation, mother's age, history of miscarriage, years of schooling of mother or attendance at prenatal sessions. After multivariate analysis, the only risk factors that remained significant were complications relating to the placenta or the umbilical cord. Deliveries involving complications relating to the placenta or the umbilical cord were three times more likely to involve fetal acidemia. CONCLUSIONS: acidemia among neonates was associated with a higher percentage of caesarians, premature births, a need for intensive care and treatment and an Apgar index of <7 in the 5th minute. After multivariate analysis, complications relating to premature displacement of the placenta and the umbilical cord were the only remaining risk factors associated with fetal acidemia