Next Generation Assessment of Fetal Wellbeing using Artificial Intelligence

电子胎儿心脏监测(也称为CTG)是使用放置在母亲腹部的探头测量胎儿心率。这是全球范围内最常见的胎儿健康测试(每年要进行2亿次测试)。它被用来尝试和评估婴儿的健康程度，并产生非常复杂的读数；令人惊讶的是，这种读数通常是用视觉(通过眼睛)分析的，执行这种分析的临床医生将使用这一点来证明婴儿是否需要分娩。有大量公布的数据表明，这种视觉评估非常糟糕，临床医生对CTG意见不一，即使是同一名医生，在不同的日子也可能对CTG有不同的解释。这意味着一些婴儿出生得太早，许多生病的婴儿出生得太晚--这两者都给婴儿、他们的父母、NHS和社会带来了重大问题。CTG可在怀孕期间、临产前或临产时进行。大多数死产发生在临产前(80%)，我们一直专注于这一领域。许多团体(包括我们自己)试图使用基本的计算机评估来标准化CTG读数的评估。这些系统当然减少了临床医生之间的分歧，但不能考虑使CTG正常或异常的多种因素(例如，没有系统考虑婴儿的胎龄-例如，将28周的婴儿与38周的婴儿同等对待)。这些系统没有将产妇或胎儿疾病纳入分析，这些系统都无法告诉临床医生未来几天或几周内婴儿会发生什么。我们汇集了一个在CTG和人工智能方面拥有专业知识的团队，以提供下一代胎儿评估。我们将开发一套基于人工智能的机器学习模型，以彻底改变产前CTG分析。深度神经网络(DNN)的最新进展使我们能够对这些复杂信号模式中的新特征进行高级分析和识别，我们可以结合详细的母婴临床结果来生成高保真的诊断和预后工具。我们拥有一个独特的无与伦比的数据库，包含165,000个完全分类的CTG信号，以及56,000个妊娠的相关孕妇和新生儿结局数据。利用这些数据，我们将开发基于人工智能的技术，专门针对母亲和胎儿(在任何孕龄)的独特背景。我们在使用这些基于人工智能的工具分析大型数据集方面拥有成熟的经验。我们已经在我们的计划中加入了用牛津和墨尔本的预期数据来验证我们的发现的能力。潜在的健康益处是巨大的。我们的工作流将允许我们生成干净的数据，生成允许我们的人工智能解决方案用于任何制造商的任何CTG的工具。我们将结合孕周、孕产妇和胎儿疾病状况，为临床医生提供准确的胎儿风险评估，这将显著改善我们在英国和其他地区照顾婴儿的方式。

Electronic Fetal Heart monitoring (also called CTG) is the measurement of the fetal heart rate using probes that are placed on the mother's abdomen. It is the commonest test of fetal wellbeing worldwide (>200M tests per year are performed). It is used to try and assess how healthy the baby is and produces a readout that is very complex; surprisingly this readout is usually analyzed visually (by eye) and the clinician performing this analysis will use this to justify whether a baby needs to be delivered or not. There is a substantial amount of published data that shows this visual assessment is extremely poor and groups of clinicians disagree about a CTG and even the same doctor can interpret a CTG differently on different days. This means that some babies are delivered too soon and many sick babies are delivered too late - both create major problems for the babies, their parents, the NHS and society. CTG can be performed in pregnancy before labour or during labour. Most stillbirths occur before labour (>80%) and we have focused on this area.Many groups (including ourselves) have tried to standardize assessment of the CTG readouts using rudimentary computerised assessment. These systems certainly reduce the disagreements between clinicians but can't account for the multiple factors that make a CTG normal or abnormal (e.g. no systems account for the gestational age of a baby - e.g. treating a 28 week baby the same as a 38 week baby. These systems don't incorporate maternal or fetal disease into the analysis and none of these systems can tell clinicians what will happen to the baby in the coming days or weeks.We have brought together a team with expertise in CTG and artificial intelligence to deliver next generation assessment of the fetus.We will develop a suite of artificial intelligence based machine-learning models to revolutionise antepartum CTG analysis. Recent advances in deep-neural-networks (DNN) enable advanced analysis and identification of novel features within these complex signal patterns which we can exploit in conjunction with detailed maternal and fetal clinical outcomes to generate high fidelity diagnostic and prognostic tools. At our disposal is a unique unrivaled database of >165,000 fully classified CTG signals with associated maternal and neonatal outcome data from >56,000 pregnancies. Leveraging these data, we will develop artificial intelligence based technologies specific to the unique context of the mother and the fetus (at any gestational age). We have proven experience of analysing large datasets using these AI based tools. We have built into our plans the ability to validate our findings with prospective data from Oxford and Melbourne. The potential health benefits are substantial.Our work streams will allow us to generate clean data, generate tools that will allow our AI solution to be used on any CTG from any manufacturer. We will incorporate gestational age, maternal and fetal disease status and provide clinicians with a precise risk assessment of the fetus that will significantly improve the way we care for babies in the UK and beyond.