Integration of clinical features in a computerized cardiotocography system to predict severe newborn acidemia

Abstract

Background: Cardiotocography (CTG), used during labor to assess fetal wellbeing, is subject to interobserver variability. Computerized CTG is a promising tool to improve fetal hypoxia detection.

Objective: To assess if adding clinical features improves the performance of a computerized CTG system to predict severe newborn acidemia (blood cord pH below 7.05).

Methods: A retrospective multicentric database was built using the data from two sources (the open-source CTU-UHB database and the data from Beaujon university hospital). Four CTG features were extracted from the fetal heart rate (FHR) signal (minimum and maximum value of the baseline, area covered by the accelerations and decelerations). Clinical features were also collected. Severe fetal acidemia was defined by arterial pH < 7.05 on umbilical cord sample. Risk factors for severe acidemia were sought by comparing cases with severe newborn acidemia to the rest of the cohort. We evaluated the accuracy of the model using both CTG and clinical features using area under the curve (AUC) in a cross-center, cross-validation approach.

Results: The datasets contained 1264 cases including 100 cases with severe acidemia. In univariate analysis, hypertensive disorders and other clinical features showed no significant difference, except for meconium-stained amniotic fluid (p = 0.03). Multivariate analysis revealed that a high deceleration area (OR = 1.09 [1.04--1.11]) and apparition of meconium amniotic fluid increased the risk of newborn acidemia (OR = 2.10[1.24-3.49]). In a k-fold cross-validation approach, DeepCTG®1.5 reached an AUC of 0.77, compared to 0.74 when using CTG features only.

Conclusion: The CTG features have a good accuracy to predict severe newborn acidemia, confirming existing literature. Integrating clinical features tends to enhance the accuracy. Further research will aim at using more advanced machine learning models to combine the features more efficiently.

Keywords: Cardiotocography; Computerized cardiotocography; Fetal hypoxia; Fetal morbidity; Labor; Newborn acidemia.