Machine Learning Techniques for Identifying Fetal Risk During Pregnancy

Cardiotocography (CTG) is a biophysical method for assessing fetal condition that primarily relies on the recording and automated analysis of fetal heart activity. The quantitative description of the CTG signals is provided by computerized fetal monitoring systems. Even though effective conclusion generation methods for decision process support are still required to find out the fetal risk such as premature embryo, this proposed method and outcome data can confirm the assessment of the fetal state after birth. Low birth weight is quite possibly the main attribute that significantly depicts an unusual fetal result. These expectations are assessed in a constant experimental decision support system, providing valuable information that can be used to obtain additional information about the fetal state using machine learning techniques. The advancements in modern obstetric practice enabled the use of numerous reliable and robust machine learning approaches in classifying fetal heart rate signals. The Naïve Bayes (NB) classifier, support vector machine (SVM), decision trees (DT), and random forest (RF) are used in the proposed method. To assess these outcomes in the proposed method, some of the metrics such as precision, accuracy, F1 score, recall, sensitivity, logarithmic loss and mean absolute error have been taken. The above mentioned metrics will be helpful to predict the fetal risk.

Association of Stillbirths with Maternal and Fetal Risk Factors in a Tertiary Care Hospital in South India

Background. Birth of a fetus with no signs of life after a predefined age of viability is a nightmare for the obstetrician. Stillbirth is a sensitive indicator of maternal care during the antepartum and intrapartum period. Though there has been a renewed global focus on stillbirth as a public health concern, the decline in stillbirth rate (SBR) has not been satisfactory across the nations, with a large number of stillbirths occurring in the low- to middle-income countries (LMICs). Hence, the study was carried out to analyze maternal and fetal risk factors and their association with stillbirths in a tertiary care center in South India. Methods. This observational prospective study included pregnant women with stillbirth beyond 20 weeks of gestation or fetal weight more than 500 grams. Stillbirths were classified according to the simplified causes of death and associated conditions (CODAC) classification. Association between the risk factor and stillbirths was calculated with chi-square test and odds ratio with 95% confidence interval. Results. There were 171 stillbirths (2.97%) among total 5755 births. The SBR was 29.71/1000 births. Risk factors such as preterm delivery (OR: 22.33, 95% CI: 15.35–32.50), anemia (OR: 21.87, 95% CI: 15.69–30.48), congenital malformation (OR: 11.24, 95% CI: 6.99–18.06), abruption (OR: 10.14, 95% CI: 6.43–15.97), oligohydramnios (OR: 4.88, 95% CI: 3.23–7.39), and hypertensive disorder (OR: 3.01, 95% CI: 2.03–4.46) were significantly associated with stillbirths. The proportion of intrapartum stillbirths was found to be 5 (3%) among the study population. Conclusion. Highest prevalent risk factors associated with stillbirth are anemia and prematurity. Intrapartum stillbirths can be reduced significantly through evidence-based clinical interventions and practices in resource-poor settings. There is a need to provide and assure access to specialized quality antenatal care to pregnant women to control the risk factors associated with stillbirths.

Pregnancy, systemic lupus erythematosus and a short communication on labor complications as new onset of the disease

Systemic lupus erythematosus (SLE) occur frequently in women of fertile age. In the pathogenesis of SLE, estrogen plays an important role, hormonal changes such as pregnancy and the postpartum increase the risk of disease flares. Also, pregnancy in SLE patients carries a higher fetal risk compared with healthy women. Pregnancy outcome may be optimized by careful planning of the pregnancy and close follow-up of the mother and of the fetus. SLE is associated with high maternal and fetal risk especially when non-diagnosed before planning a pregnancy. Herein we present two cases of SLE manifested by preeclampsia and acute renal insufficiency during labor and postpartum period, with a difficult diagnosis after a few months of a worsening clinical situation.

Transcranial Magnetic Stimulation (TMS) during pregnancy: a fetal risk factor

Objective: To examine reports of Transcranial Magnetic Stimulation (TMS) during pregnancy for evidence of fetal risk. Method: PubMed was used to locate relevant literature for the years 1998–2020 and reference lists were examined for materials not located electronically. Results: Ten reports were located dealing with 67 births over 20 years. Stimulation was applied is all trimesters, at low and high frequency, and as intermittent theta-burst stimulation. No mother or baby experienced a serious event. Conclusions: Certainty awaits large, standardized studies. However, the available reports provide no evidence that TMS to mother during pregnancy has detrimental effects on the fetus.

Imaging modalities in pregnant cancer patients

Cancer during pregnancy is increasingly diagnosed due to the trend of delaying pregnancy to a later age and probably also because of increased use of non-invasive prenatal testing for fetal aneuploidy screening with incidental finding of maternal cancer. Pregnant women pose higher challenges in imaging, diagnosis, and staging of cancer. Physiological tissue changes related to pregnancy makes image interpretation more difficult. Moreover, uncertainty about the safety of imaging modalities, fear of (unnecessary) fetal radiation, and lack of standardized imaging protocols may result in underutilization of the necessary imaging tests resulting in suboptimal staging. Due to the absence of radiation exposure, ultrasound and MRI are obvious first-line imaging modalities for detailed locoregional disease assessment. MRI has the added advantage of a more reproducible comprehensive organ or body region assessment, the ability of distant staging through whole-body evaluation, and the combination of anatomical and functional information by diffusion-weighted imaging which obviates the need for a gadolinium-based contrast-agent. Imaging modalities with inherent radiation exposure such as CT and nuclear imaging should only be performed when the maternal benefit outweighs fetal risk. The cumulative radiation exposure should not exceed the fetal radiation threshold of 100 mGy. Imaging should only be performed when necessary for diagnosis and likely to guide or change management. Radiologists play an important role in the multidisciplinary team in order to select the most optimal imaging strategies that balance maternal benefit with fetal risk and that are most likely to guide treatment decisions. Our aim is to provide an overview of possibilities and concerns in current clinical applications and developments in the imaging of patients with cancer during pregnancy.

Pregnancy with Suspected Pulmonary Arterial Hypertension: A Referral for Confirmation Prior to Termination of Pregnancy

Certain cardiovascular conditions pose a significant maternal-fetal risk during pregnancy with the greatest risk seen in pulmonary arterial hypertension (PAH). Current guidelines clearly recommend the avoidance of pregnancy in women with PAH and termination when pregnancy does occur but only after the diagnosis of PAH has been confirmed by right heart catheterization (RHC).