Establishment of Automated Technique of FHR Baseline and Variability Detection Using CTG: Statistical Comparison with Expert’s Analysis

Full Text (PDF, 717KB), PP.27-35

Views: 0 Downloads: 0


Sahana Das 1,* Kaushik Roy 2 Chanchal K. Saha 3

1. Narula Institute of Technology, Department of Computer Application, Kolkata, 700109, India

2. West Bengal State University, Department of Computer Science, Kolkata, 700124, India

3. Biraj Mohini Matrisadan and Hospital, Department of Obstetrics and Gynecology, Kolkata, 700122, India

* Corresponding author.


Received: 24 Jan. 2018 / Revised: 26 Mar. 2018 / Accepted: 18 Oct. 2018 / Published: 8 Jan. 2019

Index Terms

Cardiotocograph, Fetal Heart Rate, Baseline, Baseline Variability, Paired sample t-test


The most widely accepted method of monitoring the fetal heart rate and uterine activity of the mother is using Cardiotocograph (CTG). It simultaneously captures these two signals and correlate them to find the status of the fetus. This method is preferred by obstetricians since it is non-invasive as well as cost-effective. Though used widely, the specificity and predictive precision has not been undisputable. The main reason behind this is due to the contradiction in clinicians opinions. The two main components of CTG are Baseline and Variability which provide a thorough idea about the state of the fetal-health when CTG signals are inspected visually. These parameters are indicative of the oxygen saturation level in the fetal blood. Automated detection and analysis of these parameters is necessary for early and accurate detection of hypoxia, thus avoiding further compromise. Results of the proposed algorithm were compared with the visual assessment performed by three clinicians in this field using various statistical techniques like Confidence Interval (CI), paired sample t-test and Bland-Altman plot. The agreement between the proposed method and the clinicians’ evaluation is strong.

Cite This Paper

Sahana Das, Kaushik Roy, Chanchal K. Saha, "Establishment of Automated Technique of FHR Baseline and Variability Detection Using CTG: Statistical Comparison with Expert’s Analysis", International Journal of Information Engineering and Electronic Business(IJIEEB), Vol.11, No.1, pp. 27-35, 2019. DOI:10.5815/ijieeb.2019.01.04


[1]Royal College of Obstetrician and Gynecologist (RCOG). The use of electronic fetal monitoring. London: Evidence Based Clinical Guideline Number 8, May 2001.
[2]D. Gravilis, I. G. Tsoulos, G. Georgoulas, E. Glavas, “Classification of fetal heart rate using grammatical evaluation,” Proceedings of IEEE Workshop on Signal Processing, System Design and Implementation. p. 425 – 429, 2005.
[3]S. Das, K. Roy, and C. K. Saha, “Fuzzy membership estimation using ANN: A case study in CTG analysis,” in Advances in Intelligent Systems and Computing, vol. 327, S. Satapathy, B. Biswal., S. Udgata, J. Mandal, Eds. India: Springer, 2014, pp. 221 – 227.
[4]G. S. Dawes, G. H. Vissar, J.D Goodman, C. W. Redman, “Numerical analysis of the human fetal heart rate: the quality of ultrasound records,” American Journal of Obstet. Gynecol, vol. 141, pp. 43 – 52, Sept. 1981.
[5]A. Alonso-Betanzos, “The NST-EXPERT project: the need to evolve,” Journal of Artificial Intelligence, Med, vol.7, pp. 297–313, August 1995.
[6]D. Ayres-de-Campos, P. Sousa, A. Costa, J. Bernerdes, “Omniview-SisPorto® 3.5 - A central fetal monitoring station with online alerts based on computerized cardiotocogram+ST event analysis,” Journal of Perinatal Medicine, 2008, vol. 36, pp. 260–264, 2008.
[7]B. Guijarro-Berdiñas, A. Alonso-Betanzos, “Empirical evaluation of a hybrid intelligent monitoring system using different measures of effectiveness,” J. Artificial Intelligence Medicine, vol. 24, pp.1– 6, Jan 2002.
[8]G. Magenes, M. G. Signorini, M. Ferrario, L. Pedrinazzi, D. Arduini, “Improving the fetal cardiotocographic monitoring by advanced signal processing”, 25th IEEE AICEMBS, IEEE press, vol.3, p. 2295 – 2298, Sept. 2003.
[9]K. Greene, R. Keith, K2 Medical System, 2002. Retrieved November 14, 2017, from
[10]INFANT Study, 2009. Retrieved November 14, 2017, from
[11]PeriCALM, 2010. Retrieved November 14, 2017from
[12]S. Das, K. Roy, C.K. Saha, “A novel approach for extraction and analysis of variability of baseline,” Proceedings of the IEEE International Conference on RETIS. p. 336 – 339, Dec. 2011, India.
[13]E. Chandraharan, S. Arulkumaran, “Prevention of birth asphyxia: responding appropriately to cardiotocograph traces,” Journal of Best Practices and Research Clinical Obstetrics and Gynecology, vol. 21, pp. 609 – 624, March 2007.
[14]J. Jezewski, J. Wrobel, T. Kupka, “Baseline and Acceleration Episodes – Clinically Significant Nonstationarities in FHR Signal: Part I. Coefficients of Inconsistency,” in Advances in Intelligence and Soft Computing, vol. 30 M. Kurzynski, E. Puchala, M. Wozniak, A. Zolnierek, Eds. Poland: Springer, 2005, pp. 527 – 534.
[15]G. A Macones, et al. “The 2008 national institute of child health and human development workshop report on electronic fetal monitoring: update on definitions, interpretations and research guidelines,” Journal of Obstetric, Gynecologic and Neonatal Nursing, vol. 112, pp. 661 – 666, Sept. 2008.
[16]S. Santos, D. Ayres-de-Campos, “Human factors affecting the interpretation of fetal heart rate tracings: an uUpdate,” Current Opinion in Obstetrics and Gynaecology, vol. 24, pp. 84 – 88, March 2012.
[17]Czech Technical university in Prague and University Hospital in Brno database. Retrieved Dec. 8 2014 downloaded on 08/12/2014
[18]S. Das, K. Roy, C. K. Saha, “Determination of window size for baseline estimation of fetal heart rate using CTG,” Proceedings of the Third IEEE International Conference on Computer, Communication, Control and Information Technology, p. 1 – 5, Feb. 2015.
[19]D. G. Altman, J.M. Bland, “Measurement in medicine: The analysis of method comparison studies,” The Statistician, vol. 32, pp. 307 – 317, Sept. 1983.
[20]D. G. Altman, J. M. Bland, “Measuring agreement in method comparison studies,” Statistical Methods in Medical Research, vol. 8, pp. 135 –160, June 1999.
[21]M. F. MacDorman, T. J. Matthews, A. D. Mohangoo, J. Zeitlin, “Internal comparisons of infant mortality and related factors: United States and Europe, 2010,” National Vital Statistics Reports, vol. 64, pp. 1 – 6, Sept. 2014.