Computerized intrapartum electronic fetal monitoring: Analysis of the decision to deliver for fetal distress

• Published in: 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society Vol. 2011; pp. 5888 - 5891
• Main Authors: Georgieva, A., Payne, S. J., Moulden, M., Redman, C. W. G.
• Format: Conference Proceeding Journal Article
• Language: English
• Published: United States IEEE 01-01-2011
• Subjects: Acceleration; Cardiotocography - methods; Decision Support Systems, Clinical; Decision Support Techniques; Diagnosis, Computer-Assisted - methods; Educational institutions; Feature extraction; Female; Fetal Distress - diagnosis; Fetal Distress - prevention & control; Fetal heart rate; Guidelines; Humans; Labor Presentation; Labor, Induced; Male; Monitoring; Pediatrics; Pregnancy; Reproducibility of Results; Sensitivity and Specificity
• ISBN: 9781424441211; 1424441218
• ISSN: 1094-687X; 1557-170X; 1558-4615
• DOI: 10.1109/IEMBS.2011.6091456

We applied computerized methods to assess the Electronic Fetal Monitoring (EFM) in labor. We analyzed retrospectively the last hour of EFM for 1,370 babies, delivered by emergency Cesarean sections before the onset of pushing (data collected at the John Radcliffe Hospital, Oxford, UK). There were two cohorts according to the reason for intervention: (a) fetal distress, n 1 = 524 and (b) failure to progress and/or malpresentation, n 2 = 846. The cohorts were compared in terms of classical EFM features (baseline, decelerations, variability and accelerations), computed by a dedicated Oxford system for automated analysis - OxSys. In addition, OxSys was employed to simulate current clinical guidelines for the classification of fetal monitoring, i.e. providing in real time a three-tier grading system of the EFM (normal, indeterminate, or abnormal). The computerized features and the simulated guidelines corresponded well to the clinical management and to the actual labor outcome (measured by umbilical arterial pH).