Georgieva Antoniya, Redman Christopher W G, Papageorghiou Aris T
Nuffield Department of Obstetrics and Gynecology, University of Oxford, Women's Center, John Radcliffe Hospital, Oxford, UK.
Acta Obstet Gynecol Scand. 2017 Jul;96(7):883-891. doi: 10.1111/aogs.13136. Epub 2017 May 5.
Continuous intrapartum fetal monitoring remains a significant clinical challenge. We propose using cohorts of routinely collected data. We aim to combine non-classical (data-driven) and classical cardiotocography features with clinical features into a system (OxSys), which generates automated alarms for the fetus at risk of intrapartum hypoxia. We hypothesize that OxSys can outperform clinical diagnosis of "fetal distress", when optimized and tested over large retrospective data sets.
We studied a cohort of 22 790 women in labor (≥36 weeks of gestation). Paired umbilical blood analyses were available. Perinatal outcomes were defined by objective criteria (normal; severe, moderate or mild compromise). We used the data retrospectively to develop a prototype of OxSys, by relating its alarms to perinatal outcome, and comparing its performance against standards achieved by bedside diagnosis.
OxSys1.5 triggers an alarm if the initial trace is nonreactive or the decelerative capacity (a nonclassical cardiotocography feature), exceeds a threshold, adjusted for preeclampsia and thick meconium. There were 187 newborns with severe, 613 with moderate and 3197 with mild compromise; and 18 793 with normal outcome. OxSys1.5 increased the sensitivity for compromise detection: 43.3% vs. 38.0% for severe (p = 0.3) and 36.1% vs. 31.0% for moderate (p = 0.06); and reduced the false-positive rate (14.4% vs. 16.3%, p < 0.001).
Large historic cohorts can be used to develop and optimize computerized cardiotocography monitoring, combining clinical and cardiotocography risk factors. Our simple prototype has demonstrated the principle of using such data to trigger alarms, and compares well with clinical judgment.
产时连续胎儿监护仍然是一项重大的临床挑战。我们建议使用常规收集的队列数据。我们旨在将非经典（数据驱动）和经典的胎心监护特征与临床特征整合到一个系统（OxSys）中，该系统能为有产时缺氧风险的胎儿生成自动警报。我们假设，当在大型回顾性数据集上进行优化和测试时，OxSys在诊断“胎儿窘迫”方面优于临床诊断。
我们研究了一组22790名分娩妇女（孕周≥36周）。可获得配对的脐血分析结果。围产期结局由客观标准定义（正常；严重、中度或轻度受损）。我们回顾性地使用这些数据来开发OxSys的原型，将其警报与围产期结局相关联，并将其性能与床边诊断所达到的标准进行比较。
如果初始胎心率曲线无反应或减速能力（一种非经典的胎心监护特征）超过根据子痫前期和胎粪黏稠度调整后的阈值，OxSys1.5就会触发警报。有187例新生儿严重受损，613例中度受损，3197例轻度受损；18793例结局正常。OxSys1.5提高了检测受损情况的敏感性：严重受损时为43.3%，而临床诊断为38.0%（p = 0.3）；中度受损时为36.1%，而临床诊断为31.0%（p = 0.06）；并降低了假阳性率（14.4%对16.3%，p < 0.001）。
大型历史队列可用于开发和优化结合临床和胎心监护风险因素的计算机化胎心监护。我们的简单原型已证明了利用此类数据触发警报的原理，并且与临床判断相比表现良好。
