Abstract
In-utero progress of fetal development is normally assessed through manual measurements taken from ultrasound images, requiring relatively expensive equipment and well-trained personnel. Such monitoring is therefore unavailable in low- and middle-income countries (LMICs), where most of the perinatal mortality and morbidity exists. The work presented here attempts to identify a proxy for IUGR, which is a significant contributor to perinatal death in LMICs, by determining gestational age (GA) from data derived from simple-to-use, low-cost one-dimensional Doppler ultrasound (1D-DUS) and blood pressure devices. A total of 114 paired 1D-DUS recordings and maternal blood pressure recordings were selected, based on previously described signal quality measures. The average length of 1D-DUS recording was 10.43 ± 1.41 min. The min/median/max systolic and diastolic maternal blood pressures were 79/102/121 and 50.5/63.5/78.5 mmHg, respectively. GA was estimated using features derived from the 1D-DUS and maternal blood pressure using a support vector regression (SVR) approach and GA based on the last menstrual period as a reference target. A total of 50 trials of 5-fold cross-validation were performed for feature selection. The final SVR model was retrained on the training data and then tested on a held-out set comprising 28 normal weight and 25 low birth weight (LBW) newborns. The mean absolute GA error with respect to the last menstrual period was found to be 0.72 and 1.01 months for the normal and LBW newborns, respectively. The mean error in the GA estimate was shown to be negatively correlated with the birth weight. Thus, if the estimated GA is lower than the (remembered) GA calculated from last menstruation, then this could be interpreted as a potential sign of IUGR associated with LBW, and referral and intervention may be necessary. The assessment system may, therefore, have an immediate impact if coupled with suitable intervention, such as nutritional supplementation. However, a prospective clinical trial is required to show the efficacy of such a metric in the detection of IUGR and the impact of the intervention.
Highlights
Estimation of fetal gestational age (GA) provides important information throughout pregnancy, such as delivery scheduling, growth disorder detection, and preterm newborns management (Alexander et al, 1995)
This proxy fetal assessment relies on the GA estimation approach introduced in this work, which using a pregnancy conversion factor of 40 weeks 9 months resulted in a median of 3.2 and 4.5 weeks for the normal and low birth weight (LBW) newborns, respectively
These mean absolute error (MAE) values are comparable to those presented in Marzbanrad et al (2016) and Marzbanrad et al (2017) of 2.7–5.1 weeks obtained using a step-wise regression using 1D-Doppler ultrasound signal (DUS) and fECG signals recorded by medical professionals in a high-resource/high-income country
Summary
Estimation of fetal gestational age (GA) provides important information throughout pregnancy, such as delivery scheduling, growth disorder detection, and preterm newborns management (Alexander et al, 1995). GA estimation can assist in detecting issues leading to perinatal mortality and morbidity (Rijken et al, 2014; Karl et al, 2015) This detection is needed in low-and middle-income countries (LMICs), which account for ∼98% of all reported perinatal deaths worldwide, largely due to gestational developmental issues (Zupan, 2005). In high-income countries, clinical teams generally use ultrasound images to estimate GA, as well as any structural abnormalities (Malhotra et al, 2014). These GA estimations are based on a variety of fetal measurements, such as biparietal diameter, crown-rump length, head circumference, abdominal circumference, and femur length (Malhotra et al, 2014). Van Leeuwen et al (2003) and Signorini et al (2003) reported that power in the 0.003–1.0 Hz frequency band vary during pregnancy
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