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Terefe FT, Yang B, Jemal K, Ayana D, Adefris M, Awol M, Tesema M, Dagne B, Abeje S, Bantie A, Loewenberger M, Adams SJ, Mendez I. Advancing Antenatal Care in Ethiopia: The Impact of Tele-Ultrasound on Antenatal Ultrasound Access in Rural Ethiopia. Telemed J E Health 2024. [PMID: 39229684 DOI: 10.1089/tmj.2024.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Abstract
Introduction: Access to antenatal ultrasound is limited in low-income countries such as Ethiopia. Virtual care platforms that facilitate supervision and mentoring for ultrasound scanning may improve patient access by facilitating task-sharing of antenatal ultrasound with midlevel providers. The purpose of this study was to assess the feasibility of a large volume tele-ultrasound program in Ethiopia, its impact on antenatal care (ANC) and patient access, and its sustainability as it transitioned from a pilot project to a continuing clinical program. Methods: Health care providers at two health centers in the North Shoa Zone, Ethiopia, performed antenatal tele-ultrasound exams with remote guidance from obstetricians located in urban areas. Data regarding ANC and ultrasound utilization, participant travel, ultrasound findings, specialist referrals, and participant experience were collected through a mobile app. Results: Between November 2020 and December 2023, 7,297 tele-ultrasound exams were performed. Of these, 489 tele-ultrasound exams were performed during the period of data collection from October to December 2022. The availability of tele-ultrasound at the two health centers significantly reduced participant travel distance (4.2 km vs. 10.2 km; p < 0.01; one-way distance). Most participants (99.2%) indicated the tele-ultrasound service was very important or important, with high levels of satisfaction. Clinically significant findings were identified in 26 cases (5.3%), leading to necessary referrals. Conclusion: This study demonstrated the feasibility of a large volume tele-ultrasound program in Ethiopia, its impact on improving the quality of ANC, and its sustainability. These findings lay a foundation upon which low-income countries can develop tele-ultrasound programs to improve antenatal ultrasound access.
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Affiliation(s)
- Felagot Taddese Terefe
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bonnie Yang
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kemal Jemal
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Dereje Ayana
- Department of Medicine, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Mulat Adefris
- Department of Obstetrics and Gynecology, University of Gondar, Gondar, Ethiopia
| | - Mukemil Awol
- Department of Midwifery, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Mengistu Tesema
- Department of Public Health, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Bewunetu Dagne
- Department of Computer Science, College of Natural Sciences, Salale University, Fitche, Ethiopia
| | - Sandra Abeje
- Canadian Physicians for Aid and Relief, Addis Ababa, Ethiopia
| | - Alehegn Bantie
- Canadian Physicians for Aid and Relief, Addis Ababa, Ethiopia
| | | | - Scott J Adams
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Canada
| | - Ivar Mendez
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
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Gleed AD, Mishra D, Self A, Thiruvengadam R, Desiraju BK, Bhatnagar S, Papageorghiou AT, Noble JA. Statistical Characterisation of Fetal Anatomy in Simple Obstetric Ultrasound Video Sweeps. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:985-993. [PMID: 38692940 DOI: 10.1016/j.ultrasmedbio.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE We present a statistical characterisation of fetal anatomies in obstetric ultrasound video sweeps where the transducer follows a fixed trajectory on the maternal abdomen. METHODS Large-scale, frame-level manual annotations of fetal anatomies (head, spine, abdomen, pelvis, femur) were used to compute common frame-level anatomy detection patterns expected for breech, cephalic, and transverse fetal presentations, with respect to video sweep paths. The patterns, termed statistical heatmaps, quantify the expected anatomies seen in a simple obstetric ultrasound video sweep protocol. In this study, a total of 760 unique manual annotations from 365 unique pregnancies were used. RESULTS We provide a qualitative interpretation of the heatmaps assessing the transducer sweep paths with respect to different fetal presentations and suggest ways in which the heatmaps can be applied in computational research (e.g., as a machine learning prior). CONCLUSION The heatmap parameters are freely available to other researchers (https://github.com/agleed/calopus_statistical_heatmaps).
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Affiliation(s)
- Alexander D Gleed
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
| | - Divyanshu Mishra
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Alice Self
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | | | | | | | - Aris T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - J Alison Noble
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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Bockarie MJ, Ansumana R, Machingaidze SG, de Souza DK, Fatoma P, Zumla A, Lee SS. Transformative potential of artificial intelligence on health care and research in Africa. Int J Infect Dis 2024; 143:107011. [PMID: 38490638 DOI: 10.1016/j.ijid.2024.107011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Affiliation(s)
- Moses J Bockarie
- College of Medical Sciences, Njala University, Bo, Sierra Leone; International Society for Infectious Diseases, Brookline, MA, USA.
| | - Rashid Ansumana
- College of Medical Sciences, Njala University, Bo, Sierra Leone; School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | - Dziedzom K de Souza
- Department of Parasitology and Department of Clinical Pathology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Patrick Fatoma
- College of Medical Sciences, Njala University, Bo, Sierra Leone
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London; NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Shui-Shan Lee
- International Society for Infectious Diseases, Brookline, MA, USA; S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
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Gadekar VP, Damaraju N, Xavier A, Thakur SB, Vijayram R, Desiraju BK, Misra S, Wadhwa N, Khurana A, Rathore S, Abraham A, Rengaswamy R, Benjamin S, Cherian AG, Bhatnagar S, Thiruvengadam R, Sinha H. Development and external validation of Indian population-specific Garbhini-GA2 model for estimating gestational age in second and third trimesters. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100362. [PMID: 39021476 PMCID: PMC467080 DOI: 10.1016/j.lansea.2024.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/02/2024] [Accepted: 01/23/2024] [Indexed: 07/20/2024]
Abstract
Background A large proportion of pregnant women in lower and middle-income countries (LMIC) seek their first antenatal care after 14 weeks of gestation. While the last menstrual period (LMP) is still the most prevalent method of determining gestational age (GA), ultrasound-based foetal biometry is considered more accurate in the second and third trimesters. In LMIC settings, the Hadlock formula, originally developed using data from a small Caucasian population, is widely used for estimating GA and foetal weight worldwide as the pre-programmed formula in ultrasound machines. This approach can lead to inaccuracies when estimating GA in a diverse population. Therefore, this study aimed to develop a population-specific model for estimating GA in the late trimesters that was as accurate as the GA estimation in the first trimester, using data from GARBH-Ini, a pregnancy cohort in a North Indian district hospital, and subsequently validate the model in an independent cohort in South India. Methods Data obtained by longitudinal ultrasonography across all trimesters of pregnancy was used to develop and validate GA models for the second and third trimesters. The gold standard for GA estimation in the first trimester was determined using ultrasonography. The Garbhini-GA2, a polynomial regression model, was developed using the genetic algorithm-based method, showcasing the best performance among the models considered. This model incorporated three of the five routinely measured ultrasonographic parameters during the second and third trimesters. To assess its performance, the Garbhini-GA2 model was compared against the Hadlock and INTERGROWTH-21st models using both the TEST set (N = 1493) from the GARBH-Ini cohort and an independent VALIDATION dataset (N = 948) from the Christian Medical College (CMC), Vellore cohort. Evaluation metrics, including root-mean-squared error, bias, and preterm birth (PTB) rates, were utilised to comprehensively assess the model's accuracy and reliability. Findings With first trimester GA dating as the baseline, Garbhini-GA2 reduced the GA estimation median error by more than three times compared to the Hadlock formula. Further, the PTB rate estimated using Garbhini-GA2 was more accurate when compared to the INTERGROWTH-21st and Hadlock formulae, which overestimated the rate by 22.47% and 58.91%, respectively. Interpretation The Garbhini-GA2 is the first late-trimester GA estimation model to be developed and validated using Indian population data. Its higher accuracy in GA estimation, comparable to GA estimation in the first trimester and PTB classification, underscores the significance of deploying population-specific GA formulae to enhance antenatal care. Funding The GARBH-Ini cohort study was funded by the Department of Biotechnology, Government of India (BT/PR9983/MED/97/194/2013). The ultrasound repository was partly supported by the Grand Challenges India-All Children Thriving Program, Biotechnology Industry Research Assistance Council, Department of Biotechnology, Government of India (BIRAC/GCI/0115/03/14-ACT). The research reported in this publication was made possible by a grant (BT/kiData0394/06/18) from the Grand Challenges India at Biotechnology Industry Research Assistance Council (BIRAC), an operating division jointly supported by DBT-BMGF-BIRAC. The external validation study at CMC Vellore was partly supported by a grant (BT/kiData0394/06/18) from the Grand Challenges India at Biotechnology Industry Research Assistance Council (BIRAC), an operating division jointly supported by DBT-BMGF-BIRAC and by Exploratory Research Grant (SB/20-21/0602/BT/RBCX/008481) from Robert Bosch Centre for Data Science and Artificial Intelligence (RBCDSAI), IIT Madras. An alum endowment from Prakash Arunachalam (BIO/18-19/304/ALUM/KARH) partly funded this study at the Centre for Integrative Biology and Systems Medicine, IIT Madras.
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Affiliation(s)
- Veerendra P. Gadekar
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
- Robert Bosch Centre for Data Science and Artificial Intelligence, Indian Institute of Technology Madras, Chennai, India
| | - Nikhita Damaraju
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
| | - Ashley Xavier
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
| | - Shambo Basu Thakur
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
| | - Ramya Vijayram
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
| | - Bapu Koundinya Desiraju
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, India
| | - Sumit Misra
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, India
| | - Nitya Wadhwa
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, India
| | - Ashok Khurana
- The Ultrasound Lab, Defence Colony, New Delhi, India
| | - Swati Rathore
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Anuja Abraham
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Raghunathan Rengaswamy
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
- Department of Chemical Engineering, Indian Institute of Technology Madras, Chennai, India
- Robert Bosch Centre for Data Science and Artificial Intelligence, Indian Institute of Technology Madras, Chennai, India
| | - Santosh Benjamin
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
- Department of Community Health, Christian Medical College, Vellore, India
| | | | - Shinjini Bhatnagar
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, India
| | - Ramachandran Thiruvengadam
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, India
- Department of Biochemistry, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Himanshu Sinha
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
- Robert Bosch Centre for Data Science and Artificial Intelligence, Indian Institute of Technology Madras, Chennai, India
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5
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Deslandes A, Avery J, Chen H, Leonardi M, Condous G, Hull ML. Artificial intelligence as a teaching tool for gynaecological ultrasound: A systematic search and scoping review. Australas J Ultrasound Med 2024; 27:5-11. [PMID: 38434541 PMCID: PMC10902831 DOI: 10.1002/ajum.12368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Purpose The aim of this study was to investigate the current application of artificial intelligence (AI) tools in the teaching of ultrasound skills as they pertain to gynaecological ultrasound. Methods A scoping review was performed. Eight databases (MEDLINE, EMBASE, EMCARE, CINAHL, Scopus, Web of Science, IEEE Xplore and ACM digital library) were searched in December 2022 using predefined keywords. All types of publications were eligible for inclusion so long as they reported the use of an AI tool, included reference to or discussion of teaching or the improvement of ultrasound skills and pertained to gynaecological ultrasound. Conference abstracts and non-English language papers which could not be adequately translated into English were excluded. Results The initial database search returned 481 articles. After screening against our inclusion and exclusion criteria, two were deemed to meet the inclusion criteria. Neither of the articles included reported original research (one systematic review and one review article). Neither of the included articles explicitly provided details of specific tools developed for the teaching of ultrasound skills for gynaecological imaging but highlighted similar applications within the field of obstetrics which could potentially be expanded. Conclusion Artificial intelligence can potentially assist in the training of sonographers and other ultrasound operators, including in the field of gynaecological ultrasound. This scoping review revealed however that to date, no original research has been published reporting the use or development of such a tool specifically for gynaecological ultrasound.
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Affiliation(s)
- Alison Deslandes
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Jodie Avery
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Hsiang‐Ting Chen
- School of Computer and Mathematical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Mathew Leonardi
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Department of Obstetrics and GynecologyMcMaster UniversityHamiltonOntarioCanada
| | - George Condous
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - M. Louise Hull
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
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6
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Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF, West KP, Shamim AA, Christian P, Ali H, Baqui AH, Saha SK, Ahmed S, Roy AD, Silveira MF, Buffarini R, Shapiro R, Zash R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zhu Z, Zeng L, Gebreyesus SH, Tesfamariam K, Adu-Afarwuah S, Dewey KG, Gyaase S, Poku-Asante K, Boamah Kaali E, Jack D, Ravilla T, Tielsch J, Taneja S, Chowdhury R, Ashorn P, Maleta K, Ashorn U, Mangani C, Mullany LC, Khatry SK, Ramokolo V, Zembe-Mkabile W, Fawzi WW, Wang D, Schmiegelow C, Minja D, Msemo OA, Lusingu JPA, Smith ER, Masanja H, Mongkolchati A, Keentupthai P, Kakuru A, Kajubi R, Semrau K, Hamer DH, Manasyan A, Pry JM, Chasekwa B, Humphrey J, Black RE. Neonatal mortality risk of vulnerable newborns by fine stratum of gestational age and birthweight for 230 679 live births in nine low- and middle-income countries, 2000-2017. BJOG 2024. [PMID: 38228570 DOI: 10.1111/1471-0528.17743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To describe the mortality risks by fine strata of gestational age and birthweight among 230 679 live births in nine low- and middle-income countries (LMICs) from 2000 to 2017. DESIGN Descriptive multi-country secondary data analysis. SETTING Nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. POPULATION Liveborn infants from 15 population-based cohorts. METHODS Subnational, population-based studies with high-quality birth outcome data were invited to join the Vulnerable Newborn Measurement Collaboration. All studies included birthweight, gestational age measured by ultrasound or last menstrual period, infant sex and neonatal survival. We defined adequate birthweight as 2500-3999 g (reference category), macrosomia as ≥4000 g, moderate low as 1500-2499 g and very low birthweight as <1500 g. We analysed fine strata classifications of preterm, term and post-term: ≥42+0 , 39+0 -41+6 (reference category), 37+0 -38+6 , 34+0 -36+6 ,34+0 -36+6 ,32+0 -33+6 , 30+0 -31+6 , 28+0 -29+6 and less than 28 weeks. MAIN OUTCOME MEASURES Median and interquartile ranges by study for neonatal mortality rates (NMR) and relative risks (RR). We also performed meta-analysis for the relative mortality risks with 95% confidence intervals (CIs) by the fine categories, stratified by regional study setting (sub-Saharan Africa and Southern Asia) and study-level NMR (≤25 versus >25 neonatal deaths per 1000 live births). RESULTS We found a dose-response relationship between lower gestational ages and birthweights with increasing neonatal mortality risks. The highest NMR and RR were among preterm babies born at <28 weeks (median NMR 359.2 per 1000 live births; RR 18.0, 95% CI 8.6-37.6) and very low birthweight (462.8 per 1000 live births; RR 43.4, 95% CI 29.5-63.9). We found no statistically significant neonatal mortality risk for macrosomia (RR 1.1, 95% CI 0.6-3.0) but a statistically significant risk for all preterm babies, post-term babies (RR 1.3, 95% CI 1.1-1.5) and babies born at 370 -386 weeks (RR 1.2, 95% CI 1.0-1.4). There were no statistically significant differences by region or underlying neonatal mortality. CONCLUSIONS In addition to tracking vulnerable newborn types, monitoring finer categories of birthweight and gestational age will allow for better understanding of the predictors, interventions and health outcomes for vulnerable newborns. It is imperative that all newborns from live births and stillbirths have an accurate recorded weight and gestational age to track maternal and neonatal health and optimise prevention and care of vulnerable newborns.
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Affiliation(s)
- Elizabeth A Hazel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel J Erchick
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanne Katz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne C C Lee
- Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Diaz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lee S F Wu
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keith P West
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasmot Ali
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - Abdullah H Baqui
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Mariângela F Silveira
- Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil
| | - Romina Buffarini
- Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil
| | - Roger Shapiro
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Dominique Roberfroid
- Namur University, Namur, Belgium
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Kathryn G Dewey
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | | | | | - Ellen Boamah Kaali
- Kintampo Health Research Centre, Kintampo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Darby Jack
- Columbia University's Mailman School of Public Health, New York, New York, USA
| | | | - James Tielsch
- George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Luke C Mullany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Vundli Ramokolo
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Wanga Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- College Graduate of Studies, University of South Africa, Pretoria, South Africa
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - Christentze Schmiegelow
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Minja
- National Institute of Medical Research, Tanga, Tanzania
| | | | | | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
| | | | | | - Paniya Keentupthai
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Katherine Semrau
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Albert Manasyan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert E Black
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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7
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Medjedovic E, Stanojevic M, Jonuzovic-Prosic S, Ribic E, Begic Z, Cerovac A, Badnjevic A. Artificial intelligence as a new answer to old challenges in maternal-fetal medicine and obstetrics. Technol Health Care 2024; 32:1273-1287. [PMID: 38073356 DOI: 10.3233/thc-231482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Following the latest trends in the development of artificial intelligence (AI), the possibility of processing an immense amount of data has created a breakthrough in the medical field. Practitioners can now utilize AI tools to advance diagnostic protocols and improve patient care. OBJECTIVE The aim of this article is to present the importance and modalities of AI in maternal-fetal medicine and obstetrics and its usefulness in daily clinical work and decision-making process. METHODS A comprehensive literature review was performed by searching PubMed for articles published from inception up until August 2023, including the search terms "artificial intelligence in obstetrics", "maternal-fetal medicine", and "machine learning" combined through Boolean operators. In addition, references lists of identified articles were further reviewed for inclusion. RESULTS According to recent research, AI has demonstrated remarkable potential in improving the accuracy and timeliness of diagnoses in maternal-fetal medicine and obstetrics, e.g., advancing perinatal ultrasound technique, monitoring fetal heart rate during labor, or predicting mode of delivery. The combination of AI and obstetric ultrasound can help optimize fetal ultrasound assessment by reducing examination time and improving diagnostic accuracy while reducing physician workload. CONCLUSION The integration of AI in maternal-fetal medicine and obstetrics has the potential to significantly improve patient outcomes, enhance healthcare efficiency, and individualized care plans. As technology evolves, AI algorithms are likely to become even more sophisticated. However, the successful implementation of AI in maternal-fetal medicine and obstetrics needs to address challenges related to interpretability and reliability.
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Affiliation(s)
- Edin Medjedovic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
- Department of Gynecology, Obstetrics and Reproductive Medicine, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Milan Stanojevic
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Sabaheta Jonuzovic-Prosic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Emina Ribic
- Public Institution Department for Health Care of Women and Maternity of Sarajevo Canton, Sarajevo, Bosnia and Herzegovina
| | - Zijo Begic
- Department of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Anis Cerovac
- Department of Gynecology and Obstetrics Tesanj, General Hospital Tesanj, Bosnia and Herzegovina
| | - Almir Badnjevic
- International Burch University, Sarajevo, Bosnia and Herzegovina
- Genetics and Bioengineering Department, Faculty of Engineering and Natural Sciences, Sarajevo, Bosnia and Herzegovina
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8
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Slimani S, Hounka S, Mahmoudi A, Rehah T, Laoudiyi D, Saadi H, Bouziyane A, Lamrissi A, Jalal M, Bouhya S, Akiki M, Bouyakhf Y, Badaoui B, Radgui A, Mhlanga M, Bouyakhf EH. Fetal biometry and amniotic fluid volume assessment end-to-end automation using Deep Learning. Nat Commun 2023; 14:7047. [PMID: 37923713 PMCID: PMC10624828 DOI: 10.1038/s41467-023-42438-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023] Open
Abstract
Fetal biometry and amniotic fluid volume assessments are two essential yet repetitive tasks in fetal ultrasound screening scans, aiding in the detection of potentially life-threatening conditions. However, these assessment methods can occasionally yield unreliable results. Advances in deep learning have opened up new avenues for automated measurements in fetal ultrasound, demonstrating human-level performance in various fetal ultrasound tasks. Nevertheless, the majority of these studies are retrospective in silico studies, with a limited number including African patients in their datasets. In this study we developed and prospectively assessed the performance of deep learning models for end-to-end automation of fetal biometry and amniotic fluid volume measurements. These models were trained using a newly constructed database of 172,293 de-identified Moroccan fetal ultrasound images, supplemented with publicly available datasets. the models were then tested on prospectively acquired video clips from 172 pregnant people forming a consecutive series gathered at four healthcare centers in Morocco. Our results demonstrate that the 95% limits of agreement between the models and practitioners for the studied measurements were narrower than the reported intra- and inter-observer variability among expert human sonographers for all the parameters under study. This means that these models could be deployed in clinical conditions, to alleviate time-consuming, repetitive tasks, and make fetal ultrasound more accessible in limited-resource environments.
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Affiliation(s)
- Saad Slimani
- Deepecho, 10106, Rabat, Morocco.
- Ibn Rochd University Hospital, Hassan II University, 20100, Casablanca, Morocco.
| | - Salaheddine Hounka
- Telecommunications Systems Services and Networks lab (STRS Lab), INPT, 10112, Rabat, Morocco
| | - Abdelhak Mahmoudi
- Deepecho, 10106, Rabat, Morocco
- Ecole Normale Supérieure, LIMIARF, Mohammed V University in Rabat, 4014, Rabat, Morocco
| | | | - Dalal Laoudiyi
- Ibn Rochd University Hospital, Hassan II University, 20100, Casablanca, Morocco
| | - Hanane Saadi
- Mohammed VI University Hospital, 60049, Oujda, Morocco
| | - Amal Bouziyane
- Université Mohammed VI des Sciences de la Santé, Hôpital Universitaire Cheikh Khalifa, 82403, Casablanca, Morocco
| | - Amine Lamrissi
- Ibn Rochd University Hospital, Hassan II University, 20100, Casablanca, Morocco
| | - Mohamed Jalal
- Ibn Rochd University Hospital, Hassan II University, 20100, Casablanca, Morocco
| | - Said Bouhya
- Ibn Rochd University Hospital, Hassan II University, 20100, Casablanca, Morocco
| | | | | | - Bouabid Badaoui
- Laboratory of Biodiversity, Ecology, and Genome, Department of Biology, Faculty of Sciences, Mohammed V University in Rabat, 1014, Rabat, Morocco
- African Sustainable Agriculture Research Institute (ASARI), Mohammed VI Polytechnic University (UM6P), 43150, Laâyoune, Morocco
| | - Amina Radgui
- Telecommunications Systems Services and Networks lab (STRS Lab), INPT, 10112, Rabat, Morocco
| | - Musa Mhlanga
- Radboud Institute for Molecular Life Sciences, Epigenomics & Single Cell Biophysics, 6525 XZ, Nijmegen, the Netherlands
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9
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Jost E, Kosian P, Jimenez Cruz J, Albarqouni S, Gembruch U, Strizek B, Recker F. Evolving the Era of 5D Ultrasound? A Systematic Literature Review on the Applications for Artificial Intelligence Ultrasound Imaging in Obstetrics and Gynecology. J Clin Med 2023; 12:6833. [PMID: 37959298 PMCID: PMC10649694 DOI: 10.3390/jcm12216833] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Artificial intelligence (AI) has gained prominence in medical imaging, particularly in obstetrics and gynecology (OB/GYN), where ultrasound (US) is the preferred method. It is considered cost effective and easily accessible but is time consuming and hindered by the need for specialized training. To overcome these limitations, AI models have been proposed for automated plane acquisition, anatomical measurements, and pathology detection. This study aims to overview recent literature on AI applications in OB/GYN US imaging, highlighting their benefits and limitations. For the methodology, a systematic literature search was performed in the PubMed and Cochrane Library databases. Matching abstracts were screened based on the PICOS (Participants, Intervention or Exposure, Comparison, Outcome, Study type) scheme. Articles with full text copies were distributed to the sections of OB/GYN and their research topics. As a result, this review includes 189 articles published from 1994 to 2023. Among these, 148 focus on obstetrics and 41 on gynecology. AI-assisted US applications span fetal biometry, echocardiography, or neurosonography, as well as the identification of adnexal and breast masses, and assessment of the endometrium and pelvic floor. To conclude, the applications for AI-assisted US in OB/GYN are abundant, especially in the subspecialty of obstetrics. However, while most studies focus on common application fields such as fetal biometry, this review outlines emerging and still experimental fields to promote further research.
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Affiliation(s)
- Elena Jost
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Philipp Kosian
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Jorge Jimenez Cruz
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Shadi Albarqouni
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
- Helmholtz AI, Helmholtz Munich, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
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10
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Lee LH, Bradburn E, Craik R, Yaqub M, Norris SA, Ismail LC, Ohuma EO, Barros FC, Lambert A, Carvalho M, Jaffer YA, Gravett M, Purwar M, Wu Q, Bertino E, Munim S, Min AM, Bhutta Z, Villar J, Kennedy SH, Noble JA, Papageorghiou AT. Machine learning for accurate estimation of fetal gestational age based on ultrasound images. NPJ Digit Med 2023; 6:36. [PMID: 36894653 PMCID: PMC9998590 DOI: 10.1038/s41746-023-00774-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/07/2023] [Indexed: 03/11/2023] Open
Abstract
Accurate estimation of gestational age is an essential component of good obstetric care and informs clinical decision-making throughout pregnancy. As the date of the last menstrual period is often unknown or uncertain, ultrasound measurement of fetal size is currently the best method for estimating gestational age. The calculation assumes an average fetal size at each gestational age. The method is accurate in the first trimester, but less so in the second and third trimesters as growth deviates from the average and variation in fetal size increases. Consequently, fetal ultrasound late in pregnancy has a wide margin of error of at least ±2 weeks' gestation. Here, we utilise state-of-the-art machine learning methods to estimate gestational age using only image analysis of standard ultrasound planes, without any measurement information. The machine learning model is based on ultrasound images from two independent datasets: one for training and internal validation, and another for external validation. During validation, the model was blinded to the ground truth of gestational age (based on a reliable last menstrual period date and confirmatory first-trimester fetal crown rump length). We show that this approach compensates for increases in size variation and is even accurate in cases of intrauterine growth restriction. Our best machine-learning based model estimates gestational age with a mean absolute error of 3.0 (95% CI, 2.9-3.2) and 4.3 (95% CI, 4.1-4.5) days in the second and third trimesters, respectively, which outperforms current ultrasound-based clinical biometry at these gestational ages. Our method for dating the pregnancy in the second and third trimesters is, therefore, more accurate than published methods.
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Affiliation(s)
- Lok Hin Lee
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Elizabeth Bradburn
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Rachel Craik
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Mohammad Yaqub
- Intelligent Ultrasound Ltd, Hodge House, Cardiff, CF10 1DY, UK
| | - Shane A Norris
- South African Medical Research Council Developmental Pathways for Health Research Unit, Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Leila Cheikh Ismail
- College of Health Sciences, University of Sharjah, University City, United Arab Emirates
| | - Eric O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Fernando C Barros
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.,Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Ann Lambert
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Maria Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Yasmin A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Oman
| | - Michael Gravett
- Departments of Obstetrics and Gynecology and of Global Health, University of Washington, Seattle, WA, USA
| | - Manorama Purwar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - Qingqing Wu
- School of Public Health, Peking University, Beijing, China
| | - Enrico Bertino
- Dipartimento di Scienze Pediatriche e dell' Adolescenza, Struttura Complessa Direzione Universitaria Neonatologia, Università di Torino, Torino, Italy
| | - Shama Munim
- Department of Obstetrics & Gynaecology, Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
| | - Zulfiqar Bhutta
- Department of Obstetrics & Gynaecology, Division of Women & Child Health, Aga Khan University, Karachi, Pakistan.,Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Jose Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - J Alison Noble
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK. .,Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.
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11
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Lee C, Willis A, Chen C, Sieniek M, Watters A, Stetson B, Uddin A, Wong J, Pilgrim R, Chou K, Tse D, Shetty S, Gomes RG. Development of a Machine Learning Model for Sonographic Assessment of Gestational Age. JAMA Netw Open 2023; 6:e2248685. [PMID: 36598790 PMCID: PMC9857195 DOI: 10.1001/jamanetworkopen.2022.48685] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/10/2022] [Indexed: 01/05/2023] Open
Abstract
Importance Fetal ultrasonography is essential for confirmation of gestational age (GA), and accurate GA assessment is important for providing appropriate care throughout pregnancy and for identifying complications, including fetal growth disorders. Derivation of GA from manual fetal biometry measurements (ie, head, abdomen, and femur) is operator dependent and time-consuming. Objective To develop artificial intelligence (AI) models to estimate GA with higher accuracy and reliability, leveraging standard biometry images and fly-to ultrasonography videos. Design, Setting, and Participants To improve GA estimates, this diagnostic study used AI to interpret standard plane ultrasonography images and fly-to ultrasonography videos, which are 5- to 10-second videos that can be automatically recorded as part of the standard of care before the still image is captured. Three AI models were developed and validated: (1) an image model using standard plane images, (2) a video model using fly-to videos, and (3) an ensemble model (combining both image and video models). The models were trained and evaluated on data from the Fetal Age Machine Learning Initiative (FAMLI) cohort, which included participants from 2 study sites at Chapel Hill, North Carolina (US), and Lusaka, Zambia. Participants were eligible to be part of this study if they received routine antenatal care at 1 of these sites, were aged 18 years or older, had a viable intrauterine singleton pregnancy, and could provide written consent. They were not eligible if they had known uterine or fetal abnormality, or had any other conditions that would make participation unsafe or complicate interpretation. Data analysis was performed from January to July 2022. Main Outcomes and Measures The primary analysis outcome for GA was the mean difference in absolute error between the GA model estimate and the clinical standard estimate, with the ground truth GA extrapolated from the initial GA estimated at an initial examination. Results Of the total cohort of 3842 participants, data were calculated for a test set of 404 participants with a mean (SD) age of 28.8 (5.6) years at enrollment. All models were statistically superior to standard fetal biometry-based GA estimates derived from images captured by expert sonographers. The ensemble model had the lowest mean absolute error compared with the clinical standard fetal biometry (mean [SD] difference, -1.51 [3.96] days; 95% CI, -1.90 to -1.10 days). All 3 models outperformed standard biometry by a more substantial margin on fetuses that were predicted to be small for their GA. Conclusions and Relevance These findings suggest that AI models have the potential to empower trained operators to estimate GA with higher accuracy.
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Affiliation(s)
- Chace Lee
- Google Health, Palo Alto, California
| | | | | | | | - Amber Watters
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bethany Stetson
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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