Central Computerized Automatic Fetal Heart Rate Diagnosis with a Rapid and Direct Alarm System

Abstract

Aims: This study aimed to simplify fetal monitoring, reduce inter-observer differences and false-positive diagnosis and monitor a large number of births simultaneously. Methods: Fetal signals from several births were transmitted to a central computer via local area network (LAN) or telemetry and analyzed using a multichannel timesharing system. Fetal heart rate (FHR) abnormalities were detected by using three programs: the experts' knowledge system, power spectral analysis and artificial neural network. Abnormal results were automatically communicated directly to the attending doctor. Instead of an FHR chart recorder, the original fetal signals were stored on the computer and re-processed on demand. Results: a maximal FHR score in the first stage of labor indicated a low Apgar score, and correlated with umbilical blood pH. The fetal distress index derived from the FHR score was three or more in cases of fetal acidosis. The neural network yielded probabilities of fetal outcome that coincided with the FHR score, and the neural index derived from these probabilities predicted fetal outcome. Pathological sinusoidal FHR and severe loss of FHR variability were automatically diagnosed by power spectral analysis. Perinatal mortality was 1.1 in 1.000 births, which was significantly lower using this central computerized system than the previous system, and no cases of cerebral palsy were reported 2 months after delivery. Conclusion: The central computerized automated fetal monitoring system improved fetal outcomes even in institutions dealing with a large number of births.

Algorithms for Computerized Fetal Heart Rate Diagnosis with Direct Reporting

“…Perinatal mortality was significantly reduced compared to the previous computer system without a rapid and direct reporting system, and no cerebral palsy developed, using the central fetal monitoring computer system of the present report, at Seirei Mikatahara hospital (Table 3) [19]. Computerized FHR monitoring was useful not only for the convenience of attending doctor but also for the objective and rapid detection of fetal abnormality, to prevent fetal demise and cerebral palsy caused by fetal brain damage in the pregnancy and labor.…”

Objective Numeric Fetal Monitoring without FHR Pattern Classification

“…It is particularly useful computer function to directly and quickly report risky and hazardous changes to attending doctor before or at the fetal hypoxic damage using objective data ( Table 2) [11].…”

“…In FHR diagnosis, fetal A/B ratio was used to the diagnosis of controversy late deceleration and in sick sinus bradycardia. Pathologic sinusoidal heart rate was checked in computerized FHR diagnosis [11], while the hypoxia index needs the correlation to the Apgar score. While direct reporting system was successful in multiple delivery monitoring [11].…”

Medical Informatics

“…The computer system was programmed by the FHR score calculation enabling to detect fetal asphyxia in early stage of labor, abnormal FHR changes, pathological outcome probability detected by neural network system, and FHR frequency analysis to differentiate sinusoidal FHR and physiological change and to estimate the loss of FHR variability. The abnormal FHR and potential pathologic prognosis are immediately and directly alarmed to the attending physician ( Figure 1), [1]. Such monitoring…”

“…They promotes to study previous works in the investigation of new subjects and in the writing of a medical report Central computerized automatic fetal heart rate monitoring system [1].…”