Intelligent SMOTE Based Machine learning Classification for Fetal State on Cardiotocography Dataset

A major contributor to under-five mortality is the death of children in the 1st month of life. Intrapartum complications are one of the major causes of perinatal mortality. Fetal cardiotocograph (CTGs) can be used as a monitoring tool to identify high-risk women during labor. The objective of this study was to study the precision of machine learning algorithm techniques on CTG data in identifying high-risk fetuses. CTG data of 2126 pregnant women were obtained from the University of California Irvine Machine Learning Repository. Out of 2126 CTG dataset 78% of them were normal, 14% were suspect, and 8 % had a pathological fetal state. To improve data imbalance SMOTE is applied followed by five different machine learning classification models were trained using CTG data. Sensitivity, precision, and F1 score for each class and overall accuracy of each model were obtained to predict normal, suspect, and pathological fetal states. For the model validity two statistical parameters MCC & kappa (k) are used. SMOTE based all the classification algorithm provides the higher degree of accuracy with minimum value is 96% and RF algorithm had the highest prediction accuracy about 98.01% which is quite satisfactory. Model validation statistical parameters MCC & kappa is maximum achieved by RF about 0.968 & 1 and for SVC is 0.977 & 1 respectively. Finally proposed work also compared with previous state of art techniques.

Clinical analysis of 33 cases with neonatal cerebral infarction

Objective: To investigate the etiology, clinical manifestations, diagnosis, treatment and prognosis of neonatal cerebral infarction (NCI) to further improve the understanding of the disease. Methods: Clinical data and follow-up results of 33 cases of NCI in neonatal intensive care unit of a first-class hospital from September 2009 to September 2019 were retrospectively analyzed. Results: All 33 patients were diagnosed with NCI by MRI. Among them, 31 cases (93.94%) were full-term infants, 25 cases (75.76%) were mother’s first birth, and 18 (54.55%) cases were males. Pregnancy complications were reported in 18 cases (54.55%), and 19 cases (57.58%) had perinatal hypoxia history. Seizures were the most common first symptom and clinical manifestation in the course of disease (81.8%). There were 27 cases (81.82%) of patent foramen ovale (PFO) among NCI cohort. Ischemic cerebral infarction occurred in 32 cases (96.97%). The middle cerebral artery and its branches were more frequently involved, mainly on the left side. The acute stage of NCI was managed by symptomatic support treatment, and the recovery stage involved mainly rehabilitation treatment. Among the 33 cases, five cases were lost to follow-up, two patients died, 26 patients survived without complications, one case had cerebral palsy, one case had language retardation, and six cases had dyskinesia. Poor prognosis was associated with the involvement of deep gray matter nuclei or multiple lobes, and intrapartum complications. Vaginal mode of delivery and longer hospital stay were associated with better prognosis. Conclusions: Complications leading to placental circulation disorder during pregnancy and perinatal hypoxia are common high-risk factors of NCI. The seizure is the most common clinical manifestation. There is a possible correlation between PFO and NCI. Involvement of deep gray matter or multiple lobes and intrapartum complications may indicate poor prognosis, while vaginal delivery and prolonged hospitalizations are associated with better prognosis of NCI. doi: https://doi.org/10.12669/pjms.37.7.4720 How to cite this:Yang N, He X, Yin C, Zhao L. Clinical analysis of 33 cases with neonatal cerebral infarction. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4720 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Modified biophysical profile and perinatal outcome in high risk pregnancies

Background: Aim and objective of current investigation was to evaluate perinatal outcome in high risk pregnancy with modified biophysical profile and also evaluate the efficacy of MBPP.Methods: Type of study was observational study, 100 patient fulfilling inclusion criteria were included in study. All women were subjected to modified biophysical profile comprises amniotic fluid index and non stress test. NST was performed with cardiotocogram, real time ultrasound scanning was performed. Perinatal outcome assessed in terms of admission to NICU, low birth weight, foetal distress, low APGAR score, neonatal mortality.Results: Out of 100 cases, 55 cases had reactive NST and 45 had non reactive NST. AFI was normal in 79 cases 21 cases had abnormal AFI. Diagnostic power was maximum seen with NST i.e. 76.36% (61.90% for AFI and 71.64% for combined MBPP) it indicates that NST is a good predictor to diagnose a compromised foetus.Conclusions: This study shows that pregnancy with high risk factors are associated with more chances of intrapartum complications perinatal morbidity and mortality , if MBPP was abnormal or any one parameter was abnormal, chances of perinatal morbidity were high.

The Relationship between Fetal Abdominal Wall Thickness and Intrapartum Complications amongst Mothers with Pregestational Type 2 Diabetes

Objectives. To evaluate the utility of fetal abdominal wall thickness (AWT) for predicting intrapartum complications amongst mothers with pregestational type 2 diabetes. Methods. This was a historical cohort study of pregnant mothers with pregestational type 2 diabetes delivering at a Canadian tertiary-care center between January 1, 2014, and December 31, 2018. Delivery records were reviewed to collect information about demographics and peripartum complications. Stored fetal ultrasound images from 36 weeks’ gestation were reviewed to collect fetal biometry and postprocessing measurement of AWT performed in a standardized fashion by 2 blinded and independent observers. The relationship between fetal AWT was then correlated with risk of intrapartum complications including emergency Caesarean section (CS) and shoulder dystocia. Results. 216 pregnant women with type 2 diabetes had planned vaginal deliveries and were eligible for inclusion. Mean maternal age was 31.3 years, and almost all were overweight or obese at the time of delivery (96.8%). Overall, the incidence of shoulder dystocia and emergency intrapartum CS was 7.4% and 17.6%, respectively. There was no difference in mean fetal AWT between those having a spontaneous vaginal delivery (8.2 mm (95% CI 7.9-8.5)) and those needing emergency intrapartum CS (8.1 mm (95% CI 7.4-8.8); p = 0.71 ) or shoulder dystocia (8.7 mm (95% CI 7.9-9.5); p = 0.23 ). There was strong interobserver correlation of AWT measurements ( r = 0.838 ; p < 0.00001 ). The strongest association with intrapartum complications was birthweight ( p = 0.003 ): with birthweight > 4000 grams, the relative risk of shoulder dystocia or CS is 2.75 (95% CI 1.74-4.36; p < 0.001 ). Conclusions. There was no obvious benefit of AWT measurement at 36 weeks for predicting shoulder dystocia or intrapartum CS amongst women with type 2 diabetes in our population. The strongest predictor of intrapartum complications remained birthweight, and so studies for improving estimation of fetal weight and evaluating the role of intrapartum ultrasound for predicting risk of delivery complications are still needed.

TO STUDY THE DIFFERENT COMPLICATIONS DURING ANTEPARTUM, INTRAPARTUM AND POSTPARTUM PERIODS WITH POSSIBLE MEASURES TO MANAGE TWIN PREGNANCY

Background: The present study of twins was done among the patients admitted in the department of Obstetrics and Gynecology at Sri Aurobindo Medical College and Post Graduate Institute, Indore. Method: Blood sample from the mother was collected for estimation of hemoglobin percentage to diagnose anemia, ABO & Rh typing for blood transfusion if necessary. Urine examination for albumin, sugar & acetone. Special investigations like USG done whenever possible. In maximum cases ultrasonography was done to detect or confirm presence of twins, their lie, maturity, gestational age, rule out congenital anomaly & to note any IUGR, Discordant growth. Amount of liquor also noted. Result: 143 (85.10%) babies were LBW. The main factors responsible for LBW were IUGR and prematurity. Intrauterine growth retardation affected 42 cases (24.41%) while prematurity affected 42 cases (24.41%) and 8 (9.3%) cases aborted. Intrauterine death was more common in first baby, because of malpresentations. Asphyxia was found to be slightly more in second baby in our study. Congenital anomalies were found in total 3 cases (1.78%). In one case, baby-2 was Anencephalic and in the other case baby-2 had fetal ascites. In one case baby-1 had multiple congenital anomalies with imperforate anus. Cord prolapse was present in one case. In one case (Case No. 17) first baby was presented by footling with cord prolapse LSCS was done, baby had SBA and died 1 day after birth. There were 8 abortions. All were second trimester abortions (12 weeks and 22 weeks). Conclusion: In the present study, incidence of various antepartum and intrapartum complications were less in booked cases, which shows that availability of antenatal care to more patients will further reduce their incidence and thus will decrease maternal morbidity. Keywords: Complications, Antepartum, Intrapartum & Postpartum.

Childbirth care in a regional healthcare network of the Mãe Paranaense Network

Objective: to analyze childbirth care in a regional healthcare unit within the Mãe Paranaense Network. Methods: a cross-sectional descriptive study conducted with 395 mothers applying a structured questionnaire, data analysis using the Chi-Squared test or G-test, complemented by an adjusted residual analysis (p<0.05). Results: higher education, higher income, abortion and interpartal period <2 years increased cesarean rates. Intrapartum complications and antibiotic therapy were related to cesarean sections. Most did not visit the maternity, had their delivery choice respected, had a companion and mother-baby contact; however, 28.9% did not have their delivery choice respected. Conclusion: there was a reduction in cesarean sections among multiparous, an increase in women who suffered a miscarriage, with an interpartal interval <2 years. Antibiotic therapy and disrespect for the delivery choice were greater for women undergoing cesarean sections. Use of oxytocin, presence of a companion and mother-baby contact were more evident in vaginal delivery.

‘Just an extra pair of hands’? A qualitative study of obstetric service users’ and professionals’ views towards 24/7 consultant presence on a single UK tertiary maternity unit

ObjectivesTo explore the views of maternity service users and professionals towards obstetric consultant presence 24 hours a day, 7 days a week.DesignSemistructured interviews conducted face to face with maternity service users and professionals in March and April 2016. All responses were analysed together (ie, both service users’ and professionals’ responses) using an inductive thematic analysis.SettingA large tertiary maternity unit in the North West of England that has implemented 24/7 obstetric consultant presence.ParticipantsAntenatal and postnatal inpatient service users (n=10), midwives, obstetrics and gynaecology specialty trainees and consultant obstetricians (n=10).ResultsFive themes were developed: (1) ‘Just an extra pair of hands?’(the consultant’s role), (2)the context, (3)the team, (4)trainingand(5)change for the consultant. Respondents acknowledged that obstetrics is an acute specialty, and consultants resolve intrapartum complications. However, variability in consultant experience and behaviour altered perception of its impact. Service users were generally positive towards 24/7 consultant presence but were not aware that it was not standard practice across the UK. Professionals were more pragmatic and discussed how the implementation of 24/7 working had affected their work, development of trainees and potential impacts on future consultants.ConclusionsThe findings raised several issues that should be considered by practitioners and policymakers when making decisions about the implementation of 24/7 consultant presence in other maternity units, including attributes of the consultants, the needs of maternity units, the team hierarchy, trainee development, consultants’ other duties and consultant absences.