Computerized data-driven interpretation of the intrapartum cardiotocogram: a cohort study.
Acta obstetricia et gynecologica Scandinavica, April 3, 2017
Continuous intrapartum fetal monitoring remains a significant clinical challenge. We propose utilising cohorts of routinely collected data. We aim to combine non-classical (data-driven) and classical cardiotocography (CTG) features with clinical features into a system (OxSys), which generates automated alarms for the fetus at risk of intrapartum hypoxia. We hypothesise that OxSys can outperform clinical diagnosis of ‘fetal distress’, when optimised and tested over large retrospective datasets MATERIAL AND METHODS: We studied a cohort of 22,790 labouring women (≥36 weeks gestation). Paired umbilical blood analyses were available. Perinatal outcomes were defined by objective criteria (Normal; Severe, Moderate or Mild compromise). We used the data retrospectively to develop a prototype of OxSys, by relating its alarms to perinatal outcome, and comparing its performance against standards achieved by bedside diagnosis RESULTS: OxSys1.5 triggers an alarm if the initial trace is nonreactive or the Decelerative Capacity (a non-classical CTG feature), exceeds a threshold, adjusted for preeclampsia and thick meconium. There were 187 newborns with Severe, 613 with Moderate and 3,197 with Mild compromise; and 18,793 with Normal outcome. OxSys1.5 increased the sensitivity for compromise detection: 43.3% vs. 38.0% for Severe (p=0.3) and 36.1% vs. 31.0% for Moderate (p=0.06); and reduced the false positive rate (14.4% vs. 16.3%, p
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Pubmed Link: 28369712