An ordinal classification approach for CTG categorization

Evaluation of cardiotocogram (CTG) is a standard approach employed during pregnancy and delivery. But, its interpretation requires high level expertise to decide whether the recording is Normal, Suspicious or Pathological. Therefore, a number of attempts have been carried out over the past three decades for development automated sophisticated systems. These systems are usually (multiclass) classification systems that assign a category to the respective CTG. However most of these systems usually do not take into consideration the natural ordering of the categories associated with CTG recordings. In this work, an algorithm that explicitly takes into consideration the ordering of CTG categories, based on binary decomposition method, is investigated. Achieved results, using as a base classifier the C4.5 decision tree classifier, prove that the ordinal classification approach is marginally better than the traditional multiclass classification approach, which utilizes the standard C4.5 algorithm for several performance criteria.

Investigating pH based evaluation of fetal heart rate (FHR) recordings

Cardiotocography (CTG) is a standard tool for the assessment of fetal well-being during pregnancy and delivery. However, its interpretation is associated with high inter- and intra-observer variability. Since its introduction there have been numerous attempts to develop computerized systems assisting the evaluation of the CTG recording. Nevertheless these systems are still hardly used in a delivery ward. Two main approaches to computerized evaluation are encountered in the literature; the first one emulates existing guidelines, while the second one is more of a data-driven approach using signal processing and computational methods. The latter employs preprocessing, feature extraction/selection and a classifier that discriminates between two or more classes/conditions. These classes are often formed using the umbilical cord artery pH value measured after delivery. In this work an approach to Fetal Heart Rate (FHR) classification using pH is presented that could serve as a benchmark for reporting results on the unique open-access CTU-UHB CTG database, the largest and the only freely available database of this kind. The overall results using a very small number of features and a Least Squares Support Vector Machine (LS-SVM) classifier, are in accordance to the ones encountered in the literature and outperform the results of a baseline classification scheme proving the utility of using advanced data processing methods. Therefore the achieved results can be used as a benchmark for future research involving more informative features and/or better classification algorithms.

A three class treatment of the FHR classification problem using latent class analysis labeling

Electronic Fetal Monitoring in the form of cardiotocography is routinely used for fetal assessment both during pregnancy and delivery. However its interpretation requires a high level of expertise and even then the assessment is somewhat subjective as it has been proven by the high inter and intra-observer variability. Therefore the scientific community seeks for more objective methods for its interpretation. Along this path, presented work proposes a classification approach, which is based on a latent class analysis method that attempts to produce more objective labeling of the training cases, a step which is vital in a classification problem. The method is combined with a simple logistic regression approach under two different schemes: a standard multi-class classification formulation and an ordinal classification one. The results are promising suggesting that more effort should be put in this proposed approach.

Combining latent class analysis labeling with multiclass approach for fetal heart rate categorization

The most common approach to assess fetal well-being during delivery is monitoring of fetal heart rate and uterine contractions-the cardiotocogram (CTG). Nevertheless, 40 years since the introduction of CTG to clinical practice, its evaluation is still challenging with high inter- and intra-observer variability. Therefore the development of more objective methods has become an issue of major importance in the field. Unlike the usually proposed approaches to assign classes for classification methods that rely either on biochemical parameters (e.g. pH value) or a simple aggregation of expert judgment, this work investigates the use of an alternative labeling system using latent class analysis (LCA) along with an ordinal classification scheme. The study is performed on a well-documented open-access database, where nine expert obstetricians provided CTG annotations. The LCA is proposed here to produce more objective class labels while the ordinal classification aims to explore the natural ordering, and representation of increased severity, for obtaining the final results. The results are promising suggesting that more effort should be put into this proposed approach.

A novel clinical decision support system using improved adaptive genetic algorithm for the assessment of fetal well-being

A novel clinical decision support system is proposed in this paper for evaluating the fetal well-being from the cardiotocogram (CTG) dataset through an Improved Adaptive Genetic Algorithm (IAGA) and Extreme Learning Machine (ELM). IAGA employs a new scaling technique (called sigma scaling) to avoid premature convergence and applies adaptive crossover and mutation techniques with masking concepts to enhance population diversity. Also, this search algorithm utilizes three different fitness functions (two single objective fitness functions and multi-objective fitness function) to assess its performance. The classification results unfold that promising classification accuracy of 94% is obtained with an optimal feature subset using IAGA. Also, the classification results are compared with those of other Feature Reduction techniques to substantiate its exhaustive search towards the global optimum. Besides, five other benchmark datasets are used to gauge the strength of the proposed IAGA algorithm.

A mobile multi-agent information system for ubiquitous fetal monitoring

Electronic fetal monitoring (EFM) systems integrate many previously separate clinical activities related to fetal monitoring. Promoting the use of ubiquitous fetal monitoring services with real time status assessments requires a robust information platform equipped with an automatic diagnosis engine. This paper presents the design and development of a mobile multi-agent platform-based open information systems (IMAIS) with an automated diagnosis engine to support intensive and distributed ubiquitous fetal monitoring. The automatic diagnosis engine that we developed is capable of analyzing data in both traditional paper-based and digital formats. Issues related to interoperability, scalability, and openness in heterogeneous e-health environments are addressed through the adoption of a FIPA2000 standard compliant agent development platform—the Java Agent Development Environment (JADE). Integrating the IMAIS with light-weight, portable fetal monitor devices allows for continuous long-term monitoring without interfering with a patient’s everyday activities and without restricting her mobility. The system architecture can be also applied to vast monitoring scenarios such as elder care and vital sign monitoring.

Determination of fetal state from cardiotocogram using LS-SVM with particle swarm optimization and binary decision tree

We use least squares support vector machine (LS-SVM) utilizing a binary decision tree for classification of cardiotocogram to determine the fetal state. The parameters of LS-SVM are optimized by particle swarm optimization. The robustness of the method is examined by running 10-fold cross-validation. The performance of the method is evaluated in terms of overall classification accuracy. Additionally, receiver operation characteristic analysis and cobweb representation are presented in order to analyze and visualize the performance of the method. Experimental results demonstrate that the proposed method achieves a remarkable classification accuracy rate of 91.62%.