Classification of Caesarean Section and Normal Vaginal Deliveries Using Foetal Heart Rate Signals and Advanced Machine Learning Algorithms

ABSTRACT – Background: Visual inspection of Cardiotocography traces by obstetricians and midwives is the gold standard for monitoring the wellbeing of the foetus during antenatal care. However, inter- and intra-observer variability is high with only a 30% positive predictive value for the classification of pathological outcomes. This has a significant negative impact on the perinatal foetus and often results in cardio-pulmonary arrest, brain and vital organ damage, cerebral palsy, hearing, visual and cognitive defects and in severe cases, death. This paper shows that using machine learning and foetal heart rate signals provides direct information about the foetal state and helps to filter the subjective opinions of medical practitioners when used as a decision support tool. The primary aim is to provide a proof-of-concept that demonstrates how machine learning can be used to objectively determine when medical intervention, such as caesarean section, is required and help avoid preventable perinatal deaths. Methodology: This is evidenced using an open dataset that comprises 506 controls (normal virginal deliveries) and 46 cases (caesarean due to pH ≤7.05 and pathological risk). Several machine-learning algorithms are trained, and validated, using binary classifier performance measures. Results: The findings show that deep learning classification achieves Sensitivity = 94%, Specificity = 91%, Area under the Curve = 99%, F-Score = 100%, and Mean Square Error = 1%. Conclusions: The results demonstrate that machine learning significantly improves the efficiency for the detection of caesarean section and normal vaginal deliveries using foetal heart rate signals compared with obstetrician and midwife predictions and systems reported in previous studies

Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

End-use of health policy analysis – the case of maternal mortality reduction in Nigeria

Nigeria presently has one of the highest rates of maternal mortality (MM) in the developing world. As part of efforts to reduce her MM, Nigeria's Federal Ministry of Health has formulated policies on sexual and reproductive health, health sector reform and safe motherhood. However, actual implementations of these policies have been less successful, resulting in persisting high rates ofMMin the country. Part of the reasons for this state of affairs includes the non-inclusion in the policy development process, of issues such as unsafe abortion, adolescent sexuality and early marriage. Secondly, although MM is largely driven by poverty and under-development, there is very poor understanding of this inter-relationship, with little attention given to addressing the various multisectorial issues that impact on MM. Thirdly, the lack of a conscientious and organized policy network to drive the process of policy implementation has ensured that health policies have never been implemented at a sustainable level. However, there is some evidence that political will for safe motherhood has recently increased in Nigeria, with efforts being given to prioritizing the problem as a major developmental and public health issue. Disappointingly, major challenges still remain in the actual implementation of health policies relating to the reduction of MM. We believe that strategic advocacy and public health education, improved coordination of policy networks and the use of the human rights and gender analysis frameworks will ensure better use of policy analysis for the reduction of MM in Nigeria.Key words End-use, health policy analysis, maternal mortality reduction, Nigeri

Is pregnancy associated with biochemical and haematological changes in HIV-infected Nigerian women?

Background. While there is evidence that HIV affects the course and outcome of pregnancy, reports on the effects of pregnancy on HIV infection remain conflicting, especially in low-resource settings. Methodology. A prospective study of two demographically similar cohorts of HIV-seropositive women, 154 pregnant and 151 non-pregnant, was conducted in a hospital setting in Nigeria. Results. Cases and controls were matched for age, but parity in controls was significantly higher than in cases (

Association of anti-Chlamydia antibodies with ectopic pregnancy in Benin city, Nigeria: a case-control study

Background: Ectopic pregnancy remains a major public health problem especially in many developing countries where it is a significant contributor to pregnancy related morbidity and mortality Objective: To determine the association between prior Chlamydia trachomatis infection and the risk of ectopic pregnancy. Methods: A case-control study from two tertiary health care facilities in Benin City, Nigeria. Ninety eight women with ectopic pregnancy (cases) and another 98 women with uncomplicated intrauterine pregnancy (controls) matched for age, were interviewed using a semi-structured questionnaire and evaluated for serological evidence of prior Chlamydia trachomatis infection. Results: The antibody titres in cases (48%) were significantly higher than in controls (16.3%) (p<0.001). However, the association between Chlamydia antibodies and ectopic pregnancy was attenuated when the effects of indicators of previous pelvic infections, socio-demographic characteristics, contraceptive and sexual history were controlled for. Primary level of education (OR = 6.32; CI, 2.31 – 17.3), three or more lifetime sexual partners (OR = 5.71; CI, 2.39 – 13.65) and prior history of vaginal discharge (OR = 5.00; CI, 2.03 – 12.3) were more likely to be associated with ectopic pregnancy than with the presence of antibodies to Chlamydia trachomatis (OR = 2.82; 95% CI, 1.33 – 5.95). The Population Attributable Risk was 30.9%. Conclusion: Chlamydial infections play only a limited role in the pathogenesis of ectopic pregnancy