Combination of XGBoost Analysis and Rule-Based Method for Intrapartum Cardiotocograph Classification

Pao-Lin Kuo,Lim Bee Yen,Pei-Yin Tsai,Yi-Chun Du,Po-Fan Chen

doi:10.1007/s40846-021-00642-y

Abstract

PurposeThe two major components of a cardiotocograph (CTG) are uterine contraction (UC) and fetal heart rate (FHR) signals. CTG has been widely used to monitor fetal well-being in the past 50 years. The guideline provided by the National Institute of Child Health and Human Development (NICHD) classifies CTG patterns into three categories (I, II, and III) in evaluating the status of a fetus. However, manual interpretation of CTG is time-consuming and is subjected to inter-personal bias.MethodsIn this study, we combined the rule-based method and eXtreme Gradient Boosting (XGBoost) analysis in classifying CTG patterns. Because of the persistent controversies about the Category II of NICHD, XGBoost analysis was used to classify it into IIa and IIb. A total of 68 pregnant women were enrolled in this study.ResultsThree categories (I, II, and III) were consistent in both manual interpretation by clinicians and our algorithm across all categories, and the average Kappa was about 0.72. The probability of fetal distress (FD) was 28.8% and 71.2% in the categories IIa and IIb, respectively.ConclusionThese findings show the proposed method has the potential to provide a clinical assistant tool to monitor fetal well-being and has high potential to be an assistive and warning system to reduce the burden of medical staff.

Highlights

Advanced maternal age (AMA) is defined as a phenomenon that women become pregnant at the age above 35, and it has increased in high-income economy countries recently
The data collected in this study was mainly CTG records provided by the clinical database under Institutional Review Board (IRB) program
After backtracking the CTG information, the data was given to three clinicians, their average obstetric experience more than 10 years, to interpret the relevant CTG records and classify into category I, II and III that followed

Summary

Introduction

Advanced maternal age (AMA) is defined as a phenomenon that women become pregnant at the age above 35, and it has increased in high-income economy countries recently [1]. According to previous studies [3], advanced maternal age is associated with the incidence of complications of pregnancy, such as abortion, gestational toxemia, gestational diabetes, and fetal growth retardation. These complications trouble pregnant women and affect the health of the fetuses. In 2014, scholar Dr Parker, S. pointed out that advanced maternal age would cause an increasing chance of early placental exfoliation, which would reduce the oxygen circulation rate of fetus and provoke FD [6] and may lead to growth retardation

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Discussion

Conclusion