The monitoring of fetal heart rate (FHR) and the assessment of its variability are crucial for preventing fetal compromise and adverse outcomes. However, traditional methods encounter limitations arising from equipment performance, data transmission, and subjective assessments by doctors. We have developed a tailored AI-based FHrCTG model specifically for FHR monitoring, which effectively mitigates noise interference and precisely reconstructs signals. Our model was pre-trained on a massive dataset consisting of 558,412 unlabeled data points and further refined using 7,266 expert-reviewed entries. To validate FHR, we introduced the Intersection Overlapping Labels (IOL) approach, which transforms rate analysis into categorical judgments. Testing revealed that our model demonstrates high sensitivity and specificity in detecting critical FHR decelerations (89.13% and 87.78%, respectively) and accelerations (62.5% and 92.04%, respectively). Furthermore, based on Fischer's criteria for clinical application, our model achieved impressive AUC scores of 0.7214 and 0.9643 for verifying FHR periodicity and amplitude variation, respectively.
Approximately 10% of newborns require assistance to initiate breathing at birth, and around 5% need ventilation support. Fetal heart rate (FHR) monitoring plays a crucial role in assessing fetal well-being during prenatal care, enabling the detection of abnormal patterns and supporting timely obstetric interventions to mitigate fetal risks during labor. Applying artificial intelligence (AI) methods to analyze large datasets of continuous FHR monitoring episodes with diverse outcomes may offer novel insights into predicting the risk of needing breathing assistance or interventions. Recent advances in wearable FHR monitors have enabled continuous fetal monitoring without compromising maternal mobility. However, sensor displacement during maternal movement, as well as changes in fetal or maternal position, often lead to signal dropout, resulting in gaps in recorded FHR data. Such missing data limits the extraction of meaningful insights and complicates automated (AI-based) analysis. Traditional approaches to handling missing data, such as simple interpolation techniques, often fail to preserve the spectral characteristics of the signals. In this paper, we propose a masked transformer-based autoencoder approach to reconstruct missing FHR signals by capturing both local temporal and frequency components of the data. The proposed method demonstrates robustness across varying durations of missing data and can be used for signal inpainting and forecasting. The proposed approach can be applied retrospectively to research datasets to support the development of AI-based risk algorithms. In the future, the proposed method could be integrated into wearable FHR monitoring devices to achieve earlier and more robust risk detection.
This paper presents the HRVConformer, a novel deep learning architecture for the classification of hypoxic-ischemic encephalopathy (HIE) using the instantaneous heart rate (HR) signal. Unlike conventional approaches that rely on handcrafted features, HRVConformer directly processes raw HR signals in an end-to-end manner, capturing both local and long-range dependencies through a hybrid Convolution-Transformer framework. By integrating convolutional layers for local feature extraction and Transformer-based attention mechanisms for global context modelling, the architecture effectively enhances signal representation and classification performance. The model was trained using supervised learning on a large HR dataset consisting of 1,573 one-hour epochs, including 259 one-hour expert-annotated epochs and a substantial set of weakly labelled data. A 314-hour validation set provided a robust performance estimation, while an independent 215-hour dataset with expert annotations was reserved for final testing. HR signals were extracted from electrocardiogram (ECG) recordings using an improved Pan-Tompkins algorithm, which significantly enhanced both signal quality and data availability. Experimental results demonstrate that the HRVConformer achieves an AUC of 83.23% and accuracy of 74.56% on the test set. These results surpass the performance of the Transformer, ResNet50 and fully convolutional networks baselines, highlighting the advantages of integrating convolutional and Transformer-based components for HR-based HIE classification. The proposed method provides a promising step toward a more accurate and automated assessment of HIE using HR signals. The code is available at: https://github.com/syu-kylin/HRVConformer.
Shuwen Yu, William P Marnane, Geraldine B. Boylan +1
Objective: Atrial fibrillation (AF) is the most common cardiac arrhythmia experienced by intensive care unit (ICU) patients and can cause adverse health effects. In this study, we publish a labelled ICU dataset and benchmarks for AF detection. Methods: We compared machine learning models across three data-driven artificial intelligence (AI) approaches: feature-based classifiers, deep learning (DL), and ECG foundation models (FMs). This comparison addresses a critical gap in the literature and aims to pinpoint which AI approach is best for accurate AF detection. Electrocardiograms (ECGs) from a Canadian ICU and the 2021 PhysioNet/Computing in Cardiology Challenge were used to conduct the experiments. Multiple training configurations were tested, ranging from zero-shot inference to transfer learning. Results: On average and across both datasets, ECG FMs performed best, followed by DL, then feature-based classifiers. The model that achieved the top F1 score on our ICU test set was ECG-FM through a transfer learning strategy (F1=0.89). Conclusion: This study demonstrates promising potential for using AI to build an automatic patient monitoring system. Significance: By publishing our labelled ICU dataset (LinkToBeAdded) and performance benchmarks, this work enables the research community to continue advancing the state-of-the-art in AF detection in the ICU. https://physionet.org/content/kingston-icu-af/
Sarah Nassar, Nooshin Maghsoodi, Sophia Mannina +7