Challenges of Developing Robust AI for Intrapartum Fetal Heart Rate Monitoring.

M E O'Sullivan,J M Rennie,G B Boylan,W P Marnane,M O'Riordan,E C Considine

doi:10.3389/frai.2021.765210

M E O'Sullivan, J M Rennie + Show 4 more

Open Access

https://doi.org/10.3389/frai.2021.765210

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Abstract

Background: CTG remains the only non-invasive tool available to the maternity team for continuous monitoring of fetal well-being during labour. Despite widespread use and investment in staff training, difficulty with CTG interpretation continues to be identified as a problem in cases of fetal hypoxia, which often results in permanent brain injury. Given the recent advances in AI, it is hoped that its application to CTG will offer a better, less subjective and more reliable method of CTG interpretation. Objectives: This mini-review examines the literature and discusses the impediments to the success of AI application to CTG thus far. Prior randomised control trials (RCTs) of CTG decision support systems are reviewed from technical and clinical perspectives. A selection of novel engineering approaches, not yet validated in RCTs, are also reviewed. The review presents the key challenges that need to be addressed in order to develop a robust AI tool to identify fetal distress in a timely manner so that appropriate intervention can be made. Results: The decision support systems used in three RCTs were reviewed, summarising the algorithms, the outcomes of the trials and the limitations. Preliminary work suggests that the inclusion of clinical data can improve the performance of AI-assisted CTG. Combined with newer approaches to the classification of traces, this offers promise for rewarding future development.

Highlights

Ensuring the safe passage of a baby through the birth canal remains a major challenge globally
In England, the 2019/20 annual report of NHS Resolution (NHSR), the body that oversees clinical negligence claims, stated that £2.3 billion was spent on clinical negligence payments, of which 50% went on settling obstetric claims
Cardiotocography (CTG) is a technique that measures changes in fetal heart rate (FHR) and relates it to uterine contractions (UC) in order to identify babies who are becoming short of oxygen

Summary

Introduction

Ensuring the safe passage of a baby through the birth canal remains a major challenge globally. Cardiotocography (CTG) is a technique that measures changes in fetal heart rate (FHR) and relates it to uterine contractions (UC) in order to identify babies who are becoming short of oxygen (hypoxic). The review was dominated by the large Dublin trial which enrolled 12,964 women in 1981–1983 (MacDonald et al, 1985). This trial showed no difference in neonatal mortality or cerebral palsy rates. CTG remains the only non-invasive tool available to the maternity team for continuous monitoring of fetal well-being during labour. Despite widespread use and investment in staff training, difficulty with CTG interpretation continues to be identified as a problem in cases of fetal hypoxia, which often results in permanent brain injury. Given the recent advances in AI, it is hoped that its application to CTG will offer a better, less subjective and more reliable method of CTG interpretation

Objectives

Results

Conclusion