| Summary: | The gold standard to assess whether a baby is at risk of oxygen deprivation during childbirth, is monitoring continuously the fetal heart rate with cardiotocography (CTG). The aim is to identify babies that could benefit from an emergency operative delivery (e.g., Cesarean section), in order to prevent death or permanent brain injury. The long, dynamic and complex CTG patterns are poorly understood and known to have high false positive and false negative rates. Visual interpretation by clinicians is challenging and reliable accurate fetal monitoring in labor remains an enormous unmet medical need. In this work, we applied deep learning methods to achieve data-driven automated CTG evaluation. Multimodal Convolutional Neural Network (MCNN) and Stacked MCNN models were used to analyze the largest available database of routinely collected CTG and linked clinical data (comprising more than 35000 births). We also assessed in detail the impact of the signal quality on the MCNN performance. On a large hold-out testing set from Oxford (n= 4429 births), MCNN improved the prediction of cord acidemia at birth when compared with Clinical Practice and previous computerized approaches. On two external datasets, MCNN demonstrated better performance compared to current feature extraction-based methods. Our group is the first to apply deep learning for the analysis of CTG. We conclude that MCNN hold potential for the prediction of cord acidemia at birth and further work is warranted. Despite the advances, our deep learning models are currently not suitable for the detection of severe fetal injury in the absence of cord acidemia - a heterogeneous, small, and poorly understood group. We suggest that the most promising way forward are hybrid approaches to CTG interpretation in labor, in which different diagnostic models can estimate the risk for different types of fetal compromise, incorporating clinical knowledge with data-driven analyses.
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