Organizations: University of Stavanger, Stavanger, Norway · Haydom Lutheran Hospital, Haydom, Tanzania · Stavanger University Hospital, Stavanger, Norway
Abstract
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.
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.
Short-term Heart Rate Variability (HRV) forecasting could provide clinicians with actionable lead time for detecting autonomic dysfunction and adverse cardiac events. Consumer wearable devices generate fragmented, artifact-rich HRV signals that challenge conventional forecasting approaches. In this study, we evaluated the forecasting ability of three Time Series Foundation Models (TSFMs), TimesFM, Chronos, and MOIRAI, against traditional baselines (Mean, Exponential Smoothing, and Exponentially Weighted Moving Average) on real-world wearable data collected from 49 healthy individuals. To address data fragmentation, we introduce a variability-preserving imputation method that augments linear interpolation with locally adaptive stochastic noise, retaining physiological dynamics essential for accurate forecasting. The results show that TSFMs outperformed all baselines without fine-tuning, achieving average Mean Absolute Scaled Error (MASE) between 0.81 and 0.87 across TSFMs and both context lengths (32 and 64 time steps), with Chronos and TimesFM as the top models, though MOIRAI showed limited gains over baselines. With up to a 2-hour forecast horizon, the results establish a baseline for TSFMs' performance on a real-world dataset, highlighting domain-specific fine-tuning as a promising direction for clinical deployment.
In this paper, we propose the MAEConformer, a novel self-supervised learning framework that combines the Conformer architecture with the Masked Autoencoder (MAE) paradigm for large-scale representation learning from unlabelled electroencephalography (EEG) and heart rate variability (HRV) signals. By integrating convolutional operations with Transformer-based self-attention, MAEConformer effectively captures both local temporal patterns and long-range contextual dependencies in physiological time series. To enhance reconstruction fidelity and representation quality, a multi-resolution short-time Fourier transform (MR-STFT) loss is incorporated alongside the reconstruction objective, enabling the model to jointly learn temporal and spectral characteristics across multiple scales. Modality-specific EEG and HRV MAEConformer models were pretrained on 6,030h and 4,868h of unlabelled recordings, respectively, and subsequently transferred to expert-annotated downstream tasks. Experimental results demonstrate that the learned representations provide strong transferability and data efficiency. In EEG-based hypoxic ischemic encephalopathy (HIE) severity classification, the pretrained MAE-EEG model achieved test AUCs of 97.19% and 96.56% for binary and four-class classification tasks, respectively, outperforming a range of state-of-the-art supervised and self-supervised baselines. On the HRV-based HIE severity classification task, MAE-HRV achieved a test AUC of 82.42%, surpassing both self-supervised Transformer-based and supervised convolutional baselines. These findings demonstrate the effectiveness of MAEConformer for learning robust and transferable representations across multiple physiological modalities.
Shuwen Yu, William P Marnane, Geraldine B. Boylan +1