Cardiotocograph-based labor stage classification from uterine contraction pressure during ante-partum and intra-partum period: a fuzzy theoretic approach

Computerized techniques for Cardiotocograph (CTG) based labor stage classification would support obstetrician for advance CTG analysis and would improve their predictive power for fetal heart rate (FHR) monitoring. Intrapartum fetal monitoring is necessary as it can detect the event, which ultimately leads to hypoxic ischemic encephalopathy, cerebral palsy or even fetal demise. To bridge this gap, in this paper, we propose an automated decision support system that will help the obstetrician identify the status of the fetus during ante-partum and intra-partum period. The proposed algorithm takes 30 min of 275 Cardiotocograph data and applies a fuzzy-rule based approach for identification and classification of labor from ‘toco’ signal. Since there is no gold standard to validate the outcome of the proposed algorithm, the authors used various statistical means to establish the cogency of the proposed algorithm and the degree of agreement with visual estimation were using Bland–Altman plot, Fleiss kappa (0.918 ± 0.0164 at 95% CI) and Kendall’s coefficient of concordance (W = 0.845). Proposed method was also compared against some standard machine learning classifiers like SVM, Random Forest and Naïve Bayes using weighted kappa (0.909), Bland–Altman plot (Limits of Agreement 0.094 to 0.0155 at 95% CI) and AUC-ROC (0.938). The proposed algorithm was found to be as efficient as visual estimation compared to the standard machine learning algorithms and thus can be incorporated into the automated decision support system.