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Double-sided asymmetric method for automated fetal heart rate baseline calculation

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Abstract

The fetal heart rate (FHR) signal is used to assess the well-being of a fetus during labor. Manual interpretation of the FHR is subject to high inter- and intra-observer variability, leading to inconsistent clinical decision-making. The baseline of the FHR signal is crucial for its interpretation. An automated method for baseline determination may reduce interpretation variability. Based on this claim, we present the Auto-Regressed Double-Sided Improved Asymmetric Least Squares (ARDSIAsLS) method as a baseline calculation algorithm designed to imitate expert obstetrician baseline determination. As the FHR signal is prone to a high rate of missing data, a step of gap interpolation in a physiological manner was implemented in the algorithm. The baseline of the interpolated signal was determined using a weighted algorithm of two improved asymmetric least squares smoothing models and an improved symmetric least squares smoothing model. The algorithm was validated against a ground truth determined from annotations of six expert obstetricians. FHR baseline calculation performance of the ARDSIAsLS method yielded a mean absolute error of 2.54 bpm, a max absolute error of 5.22 bpm, and a root mean square error of 2.89 bpm. In a comparison between the algorithm and 11 previously published methods, the algorithm outperformed them all. Notably, the algorithm was non-inferior to expert annotations. Automating the baseline FHR determination process may help reduce practitioner discordance and aid decision-making in the delivery room.

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Acknowledgements

Special thanks to Dr. Mordechai Bardicef, Dr. Amit Damti, Dr. Yael Goldberg, Dr. Eliyahu Gutterman, and Dr. Maayan Lahav-Sher for annotating the clinical FHR signals.

Funding

This work was supported by the Mark S. Kahn Family Fund.

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Authors and Affiliations

  1. Laboratory of Bioenergetic and Bioelectric Systems, Biomedical Engineering Faculty, Technion-IIT, Haifa, Israel

    Rotem Shapira, Yael Yaniv & Noam Keidar

  2. Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel

    Reuven Kedar

  3. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    Reuven Kedar

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  1. Rotem Shapira
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  2. Reuven Kedar
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  3. Yael Yaniv
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  4. Noam Keidar
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Contributions

NK, RS and YY conceived and designed the research. RS performed the experiments and the analysis. RS and NK designed the algorithm. RS drafted the manuscript. NK, YY and RK edited and revised the manuscript. RS, NK, YY and RK approved the final version.

Corresponding authors

Correspondence to Yael Yaniv or Noam Keidar.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Carmel Hospital Institutional Review Board (0001-22-CMC).

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Shapira, R., Kedar, R., Yaniv, Y. et al. Double-sided asymmetric method for automated fetal heart rate baseline calculation. Phys Eng Sci Med 46, 1779–1790 (2023). https://doi.org/10.1007/s13246-023-01337-1

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