Assessing Velocity and Directionality of Uterine Electrical Activity for Preterm Birth Prediction Using EHG Surface Records

Peak amplitude of the normalized power spectrum of the electromyogram of the uterus in the low frequency band is an effective predictor of premature birth

The current trends in the development of methods for non-invasive prediction of premature birth based on the electromyogram of the uterus, i.e., electrohysterogram (EHG), suggest an ever-increasing use of large number of features, complex models, and deep learning approaches. These "black-box" approaches rarely provide insights into the underlying physiological mechanisms and are not easily explainable, which may prevent their use in clinical practice. Alternatively, simple methods using meaningful features, preferably using a single feature (biomarker), are highly desirable for assessing the danger of premature birth. To identify suitable biomarker candidates, we performed feature selection using the stabilized sequential-forward feature-selection method employing learning and validation sets, and using multiple standard classifiers and multiple sets of the most widely used features derived from EHG signals. The most promising single feature to classify between premature EHG records and EHG records of all other term delivery modes evaluated on the test sets appears to be Peak Amplitude of the normalized power spectrum (PA) of the EHG signal in the low frequency band (0.125-0.575 Hz) which closely matches the known Fast Wave Low (FWL) frequency band. For classification of EHG records of the publicly available TPEHG DB, TPEHGT DS, and ICEHG DS databases, using the Partition-Synthesis evaluation technique, the proposed single feature, PA, achieved Classification Accuracy (CA) of 76.5% (AUC of 0.81). In combination with the second most promising feature, Median Frequency (MF) of the power spectrum in the frequency band above 1.0 Hz, which relates to the maternal resting heart rate, CA increased to 78.0% (AUC of 0.86). The developed method in this study for the prediction of premature birth outperforms single-feature and many multi-feature methods based on the EHG, and existing non-invasive chemical and molecular biomarkers. The developed method is fully automatic, simple, and the two proposed features are explainable.

Cyclostationary analysis of uterine EMG measurements for the prediction of preterm birth

Preterm birth (gestational age < 37 weeks) is a public health concern that causes fetal and maternal mortality and morbidity. When this condition is detected early, suitable treatment can be prescribed to delay labour. Uterine electromyography (uEMG) has gained a lot of attention for detecting preterm births in advance. However, analyzing uEMG is challenging due to the complexities associated with inter and intra-subject variations. This work aims to investigate the applicability of cyclostationary characteristics in uEMG signals for predicting premature delivery. The signals under term and preterm situations are considered from two online datasets. Preprocessing is carried out using a Butterworth bandpass filter, and spectral correlation density function is adapted using fast Fourier transform-based accumulation method (FAM) to compute the cyclostationary variations. The cyclic frequency spectral density (CFSD) and degree of cyclostationarity (DCS) are quantified to assess the existence of cyclostationarity. Features namely, maximum cyclic frequency, bandwidth, mean cyclic frequency (MNCF), and median cyclic frequency (MDCF) are extracted from the cyclostationary spectrum and analyzed statistically. uEMG signals exhibit cyclostationarity property, and these variations are found to distinguish preterm from term conditions. All the four extracted features are noted to decrease from term to preterm conditions. The results indicate that the cyclostationary nature of the signals can provide better characterization of uterine muscle contractions and could be helpful in detecting preterm birth. The proposed method appears to aid in detecting preterm birth, as analysis of uterine contractions under preterm conditions is imperative for timely medical intervention.

An open dataset with electrohysterogram records of pregnancies ending in induced and cesarean section delivery

The existing non-invasive automated preterm birth prediction methods rely on the use of uterine electrohysterogram (EHG) records coming from spontaneous preterm and term deliveries, and are indifferent to term induced and cesarean section deliveries. In order to enhance current publicly available pool of term EHG records, we developed a new EHG dataset, Induced Cesarean EHG DataSet (ICEHG DS), containing 126 30-minute EHG records, recorded early (23rd week), and/or later (31st week) during pregnancy, of those pregnancies that were expected to end in spontaneous term delivery, but ended in induced or cesarean section delivery. The records were collected at the University Medical Center Ljubljana, Ljubljana, Slovenia. The dataset includes 38 and 43, early and later, induced; 11 and 8, early and later, cesarean; and 13 and 13, early and later, induced and cesarean EHG records. This dataset enables better understanding of the underlying physiological mechanisms involved during pregnancies ending in induced and cesarean deliveries, and provides a robust and more realistic assessment of the performance of automated preterm birth prediction methods.

Prediction of Preterm Labor from the Electrohysterogram Signals Based on Different Gestational Weeks

Timely preterm labor prediction plays an important role for increasing the chance of neonate survival, the mother's mental health, and reducing financial burdens imposed on the family. The objective of this study is to propose a method for the reliable prediction of preterm labor from the electrohysterogram (EHG) signals based on different pregnancy weeks. In this paper, EHG signals recorded from 300 subjects were split into 2 groups: (I) those with preterm and term labor EHG data that were recorded prior to the 26th week of pregnancy (referred to as the PE-TE group), and (II) those with preterm and term labor EHG data that were recorded after the 26th week of pregnancy (referred to as the PL-TL group). After decomposing each EHG signal into four intrinsic mode functions (IMFs) by empirical mode decomposition (EMD), several linear and nonlinear features were extracted. Then, a self-adaptive synthetic over-sampling method was used to balance the feature vector for each group. Finally, a feature selection method was performed and the prominent ones were fed to different classifiers for discriminating between term and preterm labor. For both groups, the AdaBoost classifier achieved the best results with a mean accuracy, sensitivity, specificity, and area under the curve (AUC) of 95%, 92%, 97%, and 0.99 for the PE-TE group and a mean accuracy, sensitivity, specificity, and AUC of 93%, 90%, 94%, and 0.98 for the PL-TL group. The similarity between the obtained results indicates the feasibility of the proposed method for the prediction of preterm labor based on different pregnancy weeks.

Characterization and separation of preterm and term spontaneous, induced, and cesarean EHG records

To improve the understanding of the underlying physiological processes that lead to preterm birth, and different term delivery modes, we quantitatively characterized and assessed the separability of the sets of early (23rd week) and later (31st week) recorded, preterm and term spontaneous, induced, cesarean, and induced-cesarean electrohysterogram (EHG) records using several of the most widely used non-linear features extracted from the EHG signals. Linearly modeled temporal trends of the means of the median frequencies (MFs), and of the means of the peak amplitudes (PAs) of the normalized power spectra of the EHG signals, along pregnancy (from early to later recorded records), derived from a variety of frequency bands, revealed that for the preterm group of records, in comparison to all other term delivery groups, the frequency spectrum of the frequency band B0L (0.08-0.3 Hz) shifts toward higher frequencies, and that the spectrum of the newly identified frequency band B0L' (0.125-0.575 Hz), which approximately matches the Fast Wave Low band, becomes stronger. The most promising features to separate between the later preterm group and all other later term delivery groups appear to be MF (p=1.1⋅10^-5) in the band B0L of the horizontal signal S3, and PA (p=2.4⋅10^-8) in the band B0L' (S3). Moreover, the PA in the band B0L' (S3) showed the highest power to individually separate between the later preterm group and any other later term delivery group. Furthermore, the results suggest that in preterm pregnancies the resting maternal heart rate decreases between the 23rd and 31st week of gestation.

Assessment of Features between Multichannel Electrohysterogram for Differentiation of Labors

Electrohysterogram (EHG) is a promising method for noninvasive monitoring of uterine electrical activity. The main purpose of this study was to characterize the multichannel EHG signals to distinguish between term delivery and preterm birth, as well as deliveries within and beyond 24 h. A total of 219 pregnant women were grouped in two ways: (1) term delivery (TD), threatened preterm labor (TPL) with the outcome of preterm birth (TPL_PB), and TPL with the outcome of term delivery (TPL_TD); (2) EHG recording time to delivery (TTD) ≤ 24 h and TTD > 24 h. Three bipolar EHG signals were analyzed for the 30 min recording. Six EHG features between multiple channels, including multivariate sample entropy, mutual information, correlation coefficient, coherence, direct partial Granger causality, and direct transfer entropy, were extracted to characterize the coupling and information flow between channels. Significant differences were found for these six features between TPL and TD, and between TTD ≤ 24 h and TTD > 24 h. No significant difference was found between TPL_PB and TPL_TD. The results indicated that EHG signals of TD were more regular and synchronized than TPL, and stronger coupling between multichannel EHG signals was exhibited as delivery approaches. In addition, EHG signals propagate downward for the majority of pregnant women regardless of different labors. In conclusion, the coupling and propagation features extracted from multichannel EHG signals could be used to differentiate term delivery and preterm birth and may predict delivery within and beyond 24 h.

Prediction of Preterm Delivery from Unbalanced EHG Database

Objective: The early prediction of preterm labor can significantly minimize premature delivery complications for both the mother and infant. The aim of this research is to propose an automatic algorithm for the prediction of preterm labor using a single electrohysterogram (EHG) signal. Method: The proposed method firstly employs empirical mode decomposition (EMD) to split the EHG signal into two intrinsic mode functions (IMFs), then extracts sample entropy (SampEn), the root mean square (RMS), and the mean Teager–Kaiser energy (MTKE) from each IMF to form the feature vector. Finally, the extracted features are fed to a k-nearest neighbors (kNN), support vector machine (SVM), and decision tree (DT) classifiers to predict whether the recorded EHG signal refers to the preterm case. Main results: The studied database consists of 262 term and 38 preterm delivery pregnancies, each with three EHG channels, recorded for 30 min. The SVM with a polynomial kernel achieved the best result, with an average sensitivity of 99.5%, a specificity of 99.7%, and an accuracy of 99.7%. This was followed by DT, with a mean sensitivity of 100%, a specificity of 98.4%, and an accuracy of 98.7%. Significance: The main superiority of the proposed method over the state-of-the-art algorithms that studied the same database is the use of only a single EHG channel without using either synthetic data generation or feature ranking algorithms.