Patent Application
20220175324
Reliable assessment of fetal and maternal well-being is a persistent challenge of current prenatal monitoring technologies, including the non-invasive cardiotocography (CTG) technologies and invasive fetal scalp electrodes. The poor specificity and reliability of these techniques have the potential to lead to adverse maternal and fetal outcomes, including unnecessary cesarean sections, related post-surgical complication, inaccurate detection of fetal hypoxia and other fetal complications.
In general, the disclosure describes devices, systems, and/or methods for predicting maternal and/or fetal health outcomes based on maternal and/or fetal data. The maternal and/or fetal data (also referred to herein as “patient data”) may include, for example, data regarding sensed biopotential signals such as maternal and/or fetal electrocardiography (ECG) signals, maternal electromyography (EMG) signals, and/or other biopotential signals. The patient data may further include maternal and/or fetal biometric data such as blood pressure, weight, glucose, pH blood levels, blood oxygen level, breathing rate, patient movement, temperature, and other biometric data. In some examples, the patient data may further include data obtained from a mental health assessment, a social determinates of health (SDoH) assessment, socio-economic data for the patient, etc. The patient data may further include any data that may be relevant for the prediction of maternal and/or fetal outcomes, and the disclosure is not limited in this respect.
The techniques may assist clinicians in identification of features or patterns in patient data that could lead to sub-optimal outcomes and support real time decision-making by a clinical team, thus helping to promote timely, appropriate interventions and reducing costs associated with adverse outcomes.
In some examples, at least some of the patient data is obtained by a non-invasive wearable device. The wearable device includes a wearable (e.g., a garment or a band) worn about the torso of a pregnant mother and one or more sensors affixed to or embedded in the wearable. The one or more sensors are configured to capture, for example, ECG signals indicative of maternal and/or fetal cardiac activity, EMG signals indicative of uterine contractions, and/or other biopotential signals of the mother or the fetus.
In some examples, according to one or more techniques of the disclosure, a training data set including patient data and associated outcomes obtained for each of a plurality of patients (e.g., pregnant human mothers and their fetuses) is used to train one or more machine learning models for maternal and/or fetal outcome prediction. The machine learning model(s) relate various features of the patient data to the prediction of one or more maternal or fetal outcomes (either adverse or non-adverse).
In some examples, according to one or more techniques of the disclosure, a cloud-based pregnancy monitoring system receives patient data associated with a pregnant mother, applies the patient data to the trained machine learning model, and predicts one or more fetal and/or maternal outcomes based on the patient data.
In one example, the disclosure is directed to a method comprising: obtaining, by a computing device, maternal and/or fetal ECG or heart rate data for a patient; determining, by a computing device based on processing the maternal and/or fetal ECG or heart rate data for the patient using a machine learning model trained with historical maternal and/or fetal ECG or heart rate data, one or more predicted outcomes associated with the patient; and generating, by the computing device, one or more reports including an indication of the one or more predicted outcomes for display on one of a patient computing device or a provider computing device.
In another example, the disclosure is directed to a system comprising: one or more processors; and a memory comprising instructions that when executed by the one or more processors cause the one or more processors to: obtain maternal and/or fetal ECG or heart rate data for a patient; determine, based on processing the maternal and/or fetal ECG or heart rate data for the patient using a machine learning model trained with historical maternal and/or fetal ECG or heart rate data, one or more predicted outcomes associated with the patient; and generate one or more reports including an indication of the one or more predicted outcomes for display on one of a patient computing device or a provider computing device.
In another example, the disclosure is directed to a system comprising: a wearable device configured to be worn by a pregnant patient and including at least one sensing electrode configured to sense fetal ECG signals associated with the patient and her fetus and communicate corresponding fetal ECG data; one or more processors; and a memory comprising instructions that when executed by the one or more processors cause the one or more processors to: determine, based on processing the fetal ECG data using a machine learning model trained with historical fetal ECG data for a plurality of patients, one or more predicted outcomes associated with the patient; and generate one or more reports including an indication of the one or more predicted fetal outcomes for display on one of a patient computing device or a provider computing device.
In general, the disclosure describes devices, systems, and/or methods for predicting maternal and/or fetal health outcomes based on maternal and/or fetal data. The maternal and/or fetal data (also referred to herein as “patient data”) may include, for example, data regarding sensed biopotential signals such as maternal and/or fetal electrocardiography (ECG) signals, maternal electromyography (EMG) signals, and/or other biopotential signals. The patient data may further include maternal and/or fetal biometric data such as blood pressure, weight, glucose, pH blood levels, blood oxygen level, breathing rate, patient movement, temperature, and other biometric data. In some examples, the patient data may further include data obtained from a mental health assessment, a social determinates of health (SDoH) assessment, socio-economic data, etc. The patient data may further include any data that may be relevant for the prediction of maternal and/or fetal outcomes, and the disclosure is not limited in this respect.
The techniques may assist clinicians in identification of features or patterns in patient data that could lead to sub-optimal outcomes, support real time decision-making by the clinical team, thus helping to promote timely, appropriate interventions, and decrease overall costs associated with adverse maternal and fetal outcomes. The techniques may aid clinicians and healthcare providers to improve prenatal care and to better manage risk pregnancy patients while at home, allowing for continued monitoring and alert triggering. In addition, healthcare costs associated with pregnancy may be reduced by eliminating unnecessary travels and clinic visits, saving time and stress to future mothers. In addition, collection of relevant patient data may provide a framework for clinical and scientific research in the field of prenatal care and support continuous updates and refinements to the predictive models and the resulting predicted maternal and/or fetal outcomes.
In some examples, according to one or more techniques of the disclosure, a training data set including patient data and associated outcomes obtained for each of a plurality of patients (e.g., pregnant human mothers and their fetuses) is used to train a machine learning model for maternal and/or fetal outcome prediction. The machine learning model is indicative of features of the patient data are predictive of one or more maternal or fetal outcomes (either adverse or non-adverse).
In some examples, according to one or more techniques of the disclosure, a cloud-based pregnancy monitoring system receives patient data associated with a pregnant mother, applies the patient data to the trained machine learning model, and predicts one or more fetal and/or maternal outcomes associated with the pregnant mother based on the patient data.
Although specific examples using maternal and/or fetal ECG or heart rate data to predict one or more outcomes are described herein, it shall be understood that the disclosure also applies to prediction of outcomes using any other type of patient data, including other sensed biopotential signals, biometric data, socio-economic data, mental health data or any other data relevant to prediction of maternal and/or fetal outcomes, and that the disclosure is not limited in this respect.
The techniques of the disclosure may predict and output one or more maternal and/or fetal outcomes. Predicted fetal outcomes may include, but are not limited to, Apgar scores (e.g., 1, 5 and 10 minutes after birth), cord blood gas pH level, neonatal destination immediately after birth, admission to Neonatal Intensive Care Unit (NICU) within 48 hours of birth, NICU length of stay, resuscitation intervention, other neonatal complications, neonatal death up to 28 days after birth, etc. Predicted maternal outcomes may include, but are not limited to, mode of delivery (e.g., vaginal or C-section), reason for C-section, grade of C-section (If performed—Grades 1, 2, 3 or 4), length of stay, destination immediately after birth, admission to a higher level of care, complications (type and severity), hour of day of delivery, day of week of delivery, etc.
In some examples, one or more techniques of the disclosure combine patient data such as maternal and/or fetal ECG or heart rate data with additional patient data including biometric data such as uterine contraction data, blood pressure, weight, glucose, pH blood levels, blood oxygen level, breathing rate, patient movement, temperature; patient health assessment data such as results of a mental health assessments, a social determinates of health (SDoH) assessment, data regarding preexisting conditions, patient usage patterns (for example, the timing or update patterns when answering questions on a psychological survey), time of day, frequency or time between measurements, and/or any other patient data relevant to prediction of maternal and/or fetal outcomes for use as training data and/or input data for a current monitoring session for which one or more outcomes are predicted.
The training data may be used to generate one or more ML models for the identification of high-risk pregnancies (e.g., prediction of one or more adverse outcomes described herein). The techniques of the disclosure may help identify false predictions of fetal distress that may lead to unnecessary Cesarean sections, so that unnecessary C-Sections and the associated increase in health care costs and maternal recovery time may be minimized. At the same time, accuracy regarding the prediction of actual fetal distress may be maximized, allowing for timely interventions when needed. The techniques of the disclosure thus provide a comprehensive and accurate monitoring system that takes many types, attributes, features, and/or patterns of fetal and/or maternal data into account when predicting one or more maternal and/or fetal outcomes.
In some examples, the techniques of the disclosure include a wearable device for acquiring maternal and/or fetal biopotential (such as ECG and/or EMG) or heart rate data that a pregnant mother can use at home or other non-clinical environment, which in combination with a cloud-based remote monitoring system (e.g., telehealth and/or telemedicine system), may improve the mother's comfort and peace of mind during pregnancy. The techniques may be used to monitor the health of prenatal and postpartum patients in a remote monitoring setting. The techniques of the disclosure may also be used during labor and delivery in addition to or instead of a traditional cardiotocography (CTG) monitoring device in clinical/hospital environment.
In some examples, wearable device 150 includes a wearable (e.g., a garment or a band) configured to be worn about the torso of a pregnant mother, one or more sensors 152 affixed or embedded in the wearable, a communications interface, and a controller. The one or more sensors 152 are configured to sense one or more biopotential signals of the mother and/or the fetus, such as ECG and/or EMG signals. In some examples, the sensed physiological data includes maternal and/or fetal ECG or heart rate data; however, the disclosure is not limited in this respect. Wearable device 150 is configured to wirelessly communicate sensor data representative of the sensed physiological signals for receipt by at least one computing device, such as patient computing device 200. The wearable device controller is configured to control signal acquisition from the one or more sensors and to control wireless communication of the sensor data.
Patient computing device 200 is configured for wireless communication with wearable device 150. For example, patient computing device 200 wirelessly receives the sensor data transmitted by wearable device 150. In some examples, patient computing device 200 may include one or more personal computing devices of the patient. For example, patient computing device 200 may include a mobile computing device (e.g., smartphone, tablet, or laptop computer), a desktop computer, a smartwatch, etc. Computing device 200 and wearable device 150 may communicate using, for example, the Bluetooth® or Bluetooth® Low Energy (BLE) protocols, near field communication (NFC), or any other form of wireless communication. In some examples, patient computing device 200 includes a patient application 208 stored in a memory or other data storage device of patient computing device 208 as a computer-readable medium comprising instructions that when executed by patient computing device 200 generates one or more interactive pages for display on a user interface of patient computing device 200 that guide the patient through a monitoring session during which physiological signals are acquired by wearable device 150 and corresponding sensed patient data is communicated from wearable device 150 to patient computing device 200.
Patient computing device 200 is further configured to communicate with a variety of other devices or systems via network(s) 130. For example, computing device 200 may be configured to communicate with one or more computing systems, e.g., one or more provider computing devices 180 and/or FMS 300.
FMS 300 includes an AI engine 302, a signal analysis module 304, a patient module 306, and a provider module 308. FMS 300 further includes or is associated with one or more databases or other storage device(s) that store one or more stored machine learning (ML) model(s) 310, patient data 312, sensor data 314, and historical data 316. Sensor data 314 includes the raw data sensed by wearable device 150 during one or more patient monitoring sessions. Patient data 312 includes, for each of a plurality of patients, identification information corresponding to the patient, processed sensor data analyzed or generated by FMS 300 corresponding to one or more patient monitoring sessions, and/or one or more predicted outcomes corresponding to the one or more patient monitoring sessions. Historical data 316 includes historical maternal and/or fetal patient data associated with a plurality of patients. FMS 300 executes provider module 308 to provide remote provider-facing fetal monitoring services that support healthcare provider interaction with FMS 300 via provider portal 182 of provider computing system(s) 180. Similarly, FMS 300 executes patient module 306 to provide remote patient-facing fetal monitoring services that support patient interaction with FMS 300 via patient application 208 of patient computing device 200.
In accordance with one or more techniques of the disclosure, AI engine 302 of FMS 300 is configured to train one or more machine learning (ML) model(s) 310 based on historical patient data 316 associated with a plurality of patients to generate one or more maternal and/or fetal outcome predictions. AI engine 302 is further configured to determine, based on processing patient data for a pregnant mother using one or more ML models 310 trained with the historical patient data 316, one or more maternal and/or fetal outcome predictions for the pregnant mother.
Patient computing device(s) 200 may transmit data, including patient data received from wearable device 150, to computing system(s) 180 and/or FMS 300 via network(s) 130. The data may include sensed patient data, e.g., values of one or more biopotential signals, such as ECG and/or EMG signals, sensed by wearable device 150 and other physiological signals or data sensed or otherwise determined by wearable device 150 and/or patient computing device(s) 200. FMS 300 may retrieve data regarding patient(s) from one or more sources of electronic health records (EHR) (which may also be referred to as electronic medical records, EMR) 318 via network 130. EHR 318 may include data regarding historical (e.g., baseline) patient data, previous health events and treatments, disease states, comorbidities, demographics, height, weight, and body mass index (BMI), as examples, of patients. FMS 300 may use data from EHR 318 to configure algorithms implemented by wearable device 150, patient computing device 200 and/or FMS 300 to control acquisition of the sensed biopotential signals from wearable device 150 during a monitoring session and/or to predict maternal and/or fetal outcomes based on patient data acquired during a monitoring session for a patient.
Network(s) 130 may include one or more computing devices, such as one or more non-edge switches, routers, hubs, gateways, security devices such as firewalls, intrusion detection, and/or intrusion prevention devices, servers, cellular base stations and nodes, wireless access points, bridges, cable modems, application accelerators, or other network devices. Network(s) 130 may include one or more networks administered by service providers and may thus form part of a large-scale public network infrastructure, e.g., the Internet. Network(s) 130 may provide computing devices and systems, such as those illustrated in
Provider computing system 180 includes one or more computing devices used by providers (e.g., physicians, physician assistants, nurses, nurse midwives, pharmacists, therapists, clinical support staff, etc.) to view patient data gathered or generated during one or more patient monitoring sessions, including one or more maternal and/or fetal outcome predictions associated with the patient monitoring sessions, for one or more patients. For example, provider computing system 180 may include a provider portal 182 stored in a memory or other data storage device of provider computing system 180 as a computer-readable medium comprising instructions that when executed by provider computing system 180 generates one or more interactive pages for display on a user interface of provider computing system 180 that allow health care providers to view raw and/or processed patient data or other data generated by analysis of the patient data, including one or more predicted maternal and/or fetal outcomes, for one or more patients.
In some examples, the sensors are configured to sense maternal and/or fetal ECG signals. In other examples, one or more of the sensors may be configured to sense any one or more of a cardiotocography (CTG) signals, electromyography (EMG) signals, EMG myometrium signals, pulse oximeter signals, respiratory inductance plethysmography (RIP) (thoracic and abdominal) signals, acoustic signals, actigraphy signals, temperature information, accelerometer or movement information, photoplethysmography (PPG) (e.g., optical measurement for pulse rate and SpO2), and/or any other biopotential or physiological signal or parameter of the patient.
Wearable device further includes control electronics that process the sensed physiological signals of the patient acquired by sensors 152 and communicate the sensed patient data for receipt by patient computing device 200. In some examples, the control electronics are packaged in a core 154 configured to be removably connected to the wearable garment or band. To that end, core 154 includes one or more processors 156, a communication interface 158, storage devices 160, a sensor interface 162, and a power source 164 (e.g., one or more batteries). Sensor interface 162 includes circuitry configured to receive sensor data corresponding to the sensed physiological signals from the one or more sensors 152. Communication interface 158 is configured to support wireless communication between wearable device 150 and one or more computing devices, such as patient computing device 200. Storage devices 160 include one or more hardware memories or other data storage devices configured to store executable control instruction and/or raw sensor data associated with one or more monitoring sessions. Wearable device 150 may store sensor data temporarily during each monitoring session for wireless transmission to a computing device, or wearable device may store sensor data associated with multiple monitoring sessions for later transmission to a computing device.
Patient computing device 200 includes one or more processor(s) 202, a user interface 204, communication interface 212, data storage devices 206, and a power source 214 (e.g., one or more batteries). In some examples, patient computing device 200 may include one or more personal computing devices of the patient. For example, patient computing device 200 may include a mobile computing device (e.g., smartphone, tablet, or laptop computer), a desktop computer, a smartwatch, etc. Communication interface 212 of patient computing device 200 is configured for wireless communication with wearable device 150. For example, communication interface 212 and communication interface 158 of wearable device 150 may be configured to communicate using, for example, the Bluetooth® or Bluetooth® Low Energy (BLE) protocols, near field communication (NFC), or any other form of wireless communication.
Patient computing device 200 includes a patient application 208 stored in data storage device(s) 206. For example, patient application 208 may include a computer-readable medium comprising instructions that when executed by one or more processor(s) 202 of patient computing device 200 generates one or more interactive pages for display on a user interface 204 of patient computing device 200 that guide the patient through a monitoring session during which physiological signals are acquired by wearable device 150 and corresponding sensor data is communicated from wearable device 150 to patient computing device 200. As shown in the example of
Communication interface 204 of patient computing device 200 is further configured to communicate with a variety of other devices or systems via network(s) 130 (see
Signal analysis module 304 may apply one or more signal processing or preprocessing techniques to the raw sensor data. For example, signal analysis module 304 may apply normalization, denoising, filtering, artifact detection and/or artifact correction to any one or more of the sensed signal data received from the wearable device 150. Signal analysis modules may also perform feature extraction for the sensed biopotential signals including for example, extraction of a fetal ECG signal from a mixed maternal-fetal ECG signal, identification of one or more features of the maternal and/or fetal ECG signals including, for example, one or more features of the P wave, QRS complex, T wave, PQ interval, QRS duration, QT interval, RR interval, or other feature indicative of the electrical activity of the heart (e.g., start, end, duration, amplitude, peak-to-peak information, morphology, etc.). Signal analysis module 304 may further extract one or more features of the maternal and/or fetal heart rate signals including, for example, baseline heart rate, baseline variability, fetal heart rate variability, number of accelerations per second, number of early, late, and variable decelerations per second, number of prolonged decelerations per second, sinusoidal pattern, etc.
FMS 300 executes provider module 308 to provide remote provider-facing fetal monitoring services that support healthcare provider interaction with FMS 300 via provider portal 182 of provider computing system(s) 180. Similarly, FMS 300 executes patient module 306 to provide remote patient-facing fetal monitoring services that support patient interaction with FMS 300 via patient application 208 of patient computing device 200.
In accordance with one or more techniques of the disclosure, AI engine 302, when executed by processors 322 of FMS 300, is configured to train one or more machine learning (ML) model(s) 310 based on historical patient data 316 associated with a plurality of patients to generate one or more maternal and/or fetal outcome predictions. AI engine 302, when executed by processors 322, is further configured to determine, based on processing patient data for a pregnant mother using one or more ML models 310 trained with the historical patient data corresponding to a plurality of patients 316, one or more maternal and/or fetal outcome predictions for the pregnant mother.
Although in the examples described herein FMS 300 is described as performing the training of the ML models 310 and/or application of the models 310 to predict one or more maternal or fetal outcomes, it shall be understood that some or all of the functions described herein as being performed by FMS 300 may be performed by any one or more of wearable device 150, patient computing device 200, provider computing system 180, or any other remote, local or distributed computing device or system, and that the disclosure is not limited in this respect.
In order to capture maternal and fetal biopotential signals of sufficient quality, sensors 152 should provide good contact with the patient's skin, minimize sensor movement relative to the skin, and reduce signal noise from light movements of the patient. In some examples, sensors 152 include SilverBumps® dry electrodes available from Orbital Research, Inc. Example wearable garments that may be used to implement wearable device 150 are described in U.S. Pat. No. 9,579,055, issued Feb. 28, 2017, which is incorporated by reference herein in its entirety.
In other examples, instead of or in addition to dry electrodes, wearable device 150 may include any other type of sensing material or device to acquire the biopotential signals data, such as nanotechnology sensing devices, textile or silicon-based dry electrodes, nanotube sensors, cardiotocography (CTG) doppler transducers for acquiring signals associated with uterine contractions, and/or any other sensor that may be used to capture maternal and/or fetal biopotential signals.
In accordance with one or more techniques of the disclosure, the physiological (e.g., biopotential) signals sensed by wearable device 150 and analyzed to determine the status of the fetus and/or predict one or more maternal and/or fetal outcomes may include, but are not limited to, fetal heart rate (fHR), maternal heart rate (mHR), fetal ECG, maternal ECG, and maternal EMG signals.
To obtain the fetal ECG (
One or more features of the sensed biopotential signals may be extracted and used as inputs to a machine learning model (such as ML model(s) 310) to predict one or more maternal and/or fetal outcomes. For example, features of the fetal heart rate may include baseline heart rate, baseline variability, number of accelerations per second, number of early, late, and variable decelerations per second, number of prolonged decelerations per second, sinusoidal pattern, etc. Features of the fetal ECG may include, for example, one or more features of the P wave, QRS complex, T wave, PQ interval, QRS duration, QT interval, RR interval, or other feature indicative of the electrical activity of the heart (e.g., start, end, duration, amplitude, peak-to-peak information, morphology, etc.). In another example, analysis of the raw fetal ECG signal may be considered as well to avoid the information loss associated with such feature extraction procedures.
Similar features may also be identified for the maternal heart rate. Uterine contraction (UC) features may include baseline uterine tone, contraction frequency, start/end time of uterine contractions, amplitude of uterine contractions, duration of uterine contractions, and strength (intensity) of uterine contractions.
Example features of the fetal heart rate may include, but are not limited to, the features shown in Table 1. Similar features may also be identified with respect to the maternal heart rate.
The patient data for a particular patient may include patient data obtained during one or more previous monitoring sessions for the patient. The patient data associated with the previous monitoring sessions may thus be used to establish one or more baselines for the patient. For example, baselines with respect to maternal ECG and/or heart rate, fetal ECG and/or heart rate, etc., may be established and used as feature inputs to one or more ML models for prediction of maternal and/or fetal outcomes for the patient. In this way, longitudinal information for the patient over time may be taken into account when determining the one or more maternal and/or fetal outcome predictions for the patient.
During a training phase, AI engine 302 receives training data 344 that includes, for example, historical patient data associated with a plurality of patients. Training data 344 for a particular patient may include, for instance, values of the maternal and/or fetal ECG or heart rate data obtained during one or more monitoring sessions. The training data may include the raw heart rate trends, pressure measurements as they relate to contractions, and the matched fetal outcomes, maternal outcomes, and data about the subjects. The training data may also include umbilical cord arterial and venous pH levels for hypoxia detection.
One or more features 350A-350N may be extracted from the training data. The features may include independent and dependent variables. For example, the features may include any one or more features of the fetal ECG, the maternal ECG, the fetal heart rate, the maternal heart rate, and/or the uterine contractions (e.g., EMG). The features may also include features of other biometric data including blood pressure, weight, glucose, pH blood levels, blood oxygen level, breathing rate, patient movement, temperature, etc., feature of one or more mental health assessments, social determinates of health (SDoH) assessments, socio-economic data, and any other data that may be relevant to a determination of fetal or maternal outcomes.
In some examples, before the modelling takes place, the following features may be extracted from the raw data and used as one or more features of the training data: distribution of gestation week at delivery, distribution of fHR signal duration, percentage of records with validated cord blood gas analysis and pH level for those records, distribution of all fetal outcomes of interest in this study.
Features 350A-350N may be selected manually, for example, by a subject matter expert or automatically, for example, by a feature extractor that is part of AI engine 302. A feature extractor may also be used to indicate feature importance or weights for each of the features. Feature importance can be used to determine the relative importance of each feature with respect to the strength of the association of that feature in predicting each of the one or more outcomes 380. The set of features may be refined by performing mathematical, statistical, and heuristic procedures to identify an optimal set of inputs to AI engine 302. One or more of the features may further include one or more known maternal and/or fetal outcomes corresponding to the historical patient data for each of a plurality of patients.
In some examples, according to one or more techniques of the disclosure, AI engine 302 applies a training data set 350A-350N including patient data and associated outcomes obtained for each of a plurality of patients to train one or more ML model(s) 310 to predict one or more maternal and/or fetal outcomes. The ML model(s) are indicative of which features of the patient data are predictive of one or more maternal or fetal outcomes (either adverse or non-adverse).
During a deployment phase, the trained ML model(s) 310 may be deployed for use by AI engine 302 to predict one or more fetal and/or maternal outcomes 380 for a particular patient based on patient data 346 acquired during a monitoring session or health assessment session for the particular patient. During operation, one or more features 350A-350N are extracted from current patient data 346 acquired by a wearable device (such as wearable device 150) during the current monitoring session or health assessment session (such as via patient computing device 200 executing patient application 208). AI engine 302 processes the features 350A-350N of the current data 346 using machine learning model 310 to generate one or more predicted outcomes 380. In some examples and as shown in
The predicted outcome(s) 380 may be expressed in various ways. For example, the predicted outcome(s) 380 may include predicted future value(s) of one or more fetal and/or maternal biometric or physiological parameter(s). The predicted outcome(s) 380 may include one or more predicted outcome classification(s). The predicted outcome(s) 380 may include a probability that one or more predicted outcomes (e.g., either adverse or non-adverse) will occur at some time in the future. The predicted outcome(s) 380 may further include any one or more of a confidence interval, a confidence level, etc.
In some examples, the training data 344 includes maternal/fetal ECG and fetal heart rate data and associated outcomes obtained for each of a plurality of patients (e.g., pregnant human mothers and their fetuses), and is used to train and validate machine learning model 310 for maternal and/or fetal outcome prediction. The machine learning methods are used to determine which maternal and/or fetal ECG or heart rate patterns (e.g., fetal heart rate variability patterns or features) are predictive of adverse and/or non-adverse outcomes. The model may be tested on portion of the training dataset or on different data sets to compare approaches with the goal of developing ML model(s) 310 that outperform current methods to find patterns related to outcomes imperceptible to human interpretation. The maternal/fetal ECG and/or heart rate measurements together with the recorded outcomes as well as the patterns determined may be used as training data. The dataset may be split into a development and a holdout/test data set. The development data set may then be further divided into training and internal validation data, then used in real-time for the assessment of fetal heart rate data (such as current data 346) to predict one more or more outcomes 380. Hyperparameters such as the batch size, the initial learning rate, the number of neurons in the fully connected layers, and the number of convolutional layers may be adjusted to obtain an optimal model based on the validation set. New maternal and/or fetal heart rate data outside of the original training dataset(s) may be used to update or continuously update the machine learning model. This AI-driven assessment enables continuous improvement of the system and accuracy of the predicted outcomes.
The techniques of the disclosure thus identify features of, for example, maternal and/or fetal heart rate that may help decrease the incidence of adverse perinatal outcomes, including fetal acidemia, fetal hypoxia, and births by Cesarean section (C-section). In this way, the techniques of the disclosure may lead to early intervention intended to address or reduce the impact of predicted adverse events, resulting in improved maternal and fetal outcomes and decreased costs associated with adverse outcomes. This may help to maximize clinical effectiveness and speed to which a clinical team can react to clinical situations where there may be a need for intervention to help a mother and her unborn baby.
Maternal and/or fetal heart rate data can be captured over time using various technologies including, but not limited to, CTG (cardiotocography), fetal scalp electrodes, electrodes that capture fetal ECG (fetal electrocardiogram), acoustic sensors, etc. In some examples, the maternal and/or fetal heart rate data is captured by one or more sensors for capturing maternal/fetal ECG and EMG (contractions) signals incorporated into a wearable device such as wearable device 150 as shown in
In accordance with one or more techniques of the disclosure, the system may determine, based on processing patient data associated with a patient using one or more ML model(s) trained with historical patient data, one or more predicted outcomes associated with the patient (such as predicted outcomes 380). The predicted outcomes may include, but are not limited to:
Fetal Outcomes:
Maternal Outcomes:
Additional data may include:
In some examples, in addition or alternatively to fetal ECG/fetal heart rate, maternal ECG/maternal heart rate, and uterine contraction data, the training data 344 and/or current data 346 may include any one or more of blood pressure, weight, glucose, pH blood levels, blood oxygen level, breathing rate, patient movement, temperature, mental health assessments, social determinates of health (SDoH) assessment, other data linked to clinical data, and/or any other biometric data or data relevant to prediction of maternal and/or fetal outcomes. This training data may be used to generate the ML models for the identification of high-risk pregnancies (e.g., prediction of one or more adverse outcomes described herein). By including additional parameters, false predictions of fetal distress that may lead to unnecessary Cesarean sections may be minimized. At the same time, accuracy regarding the prediction of actual fetal distress may be maximized, allowing for timely interventions when needed. The techniques of the disclosure thus provide a comprehensive and accurate monitoring system that takes many attributes, features, and/or patterns of fetal and/or maternal heart rate into account when predicting one or more maternal and/or fetal outcomes.
Different machine learning classification models may be trained using the training data. Sensitivity, precision, and F1 score for each class and overall accuracy of each model may be obtained to predict normal, suspect, and pathological states. The ML model with the best performance on specified metrics will be then identified and reported for each identified outcome. The ML model(s) are stored as ML models 310 and used for prediction of fetal and/or maternal outcomes 380 during a current monitoring session or based on previously monitored data acquired during a session of interest.
For example, a first ML model may be trained to predict a preterm labor risk. A second ML model may be trained to predict a preeclampsia risk. A third ML model may be trained to predict a C-section risk related to preeclampsia, diabetes, and/or body mass index (BMI). A fourth ML model may be trained to predict “high-risk” pregnancies. Similarly, one or more additional ML models may be trained to predict one or more outcomes. In this way, multiple ML models may be generated, each associated with one or more adverse or non-adverse outcomes. The ML models may be stored (e.g., as ML model(s) 310 as shown in
In some examples, the techniques of the disclosure develop prediction models using any one or more of generalized or specialized machine learning applications. These may include, for example, any one or more of random forest (RF), RBF kernel SVM, linear SVM, linear regression and/or logistic regression techniques. The machine learning techniques may further include any one or more of deep multilayer perceptrons (MLP), convolutional or deep convolutional neural networks (CNN), recurrent neural networks (RNN), long short-term memory neural networks (LSTM), artificial neural network (ANN), deep belief networks (DBN), Bayesian networks, autoregressive models, fuzzy-logic systems, hidden Markov models (HMM), Gaussian process models, etc. In one example, the techniques of the disclosure develop prediction models using a Convolutional Neural Network (CNN) and/or a Recurrent Neural Network (RNN) approach based on the Keras Framework with a Tensorflow (Google, Mountain View, Calif.) backend. In the example of a CNN, a CNN consists of an input and an output layer, as well as multiple hidden layers. Hidden layers of a CNN typically include convolutional layers, pooling layers and fully connected layers that are used to extract features. During training of a CNN, for example, the weights of the convolutional filters may be adjusted to extract meaningful and relevant features in an unsupervised way, and each task may be defined by the outcome to be predicted.
In some examples, before continuous data, such as fetal heart rate recordings, are used as input for any of the techniques described above, they undergo a segmentation procedure. Each recording is randomly partitioned in n different ways into recordings of length A.
The computing device may further determine if the predicted outcome is an adverse outcome (558). If the predicted outcome is not an adverse outcome (NO branch of 558), the process of predicting one or more maternal or fetal outcomes for the monitoring session is complete. If the predicted outcome is an adverse outcome (YES branch of 558), the computing device may generate one or more reports including an indication of a suggested action or actions that may be taken to address the predicted adverse outcome(s) (560). For example, the suggested actions for a patient may include a suggestion that the patient change one or more habits, a suggestion that the patient contact their healthcare provider, a suggestion that the patient change the frequency of their monitoring sessions, etc. As another example, the suggested actions for a provider may include a diagnostic suggestion, an intervention suggestion, a care plan suggestion, etc.
As one specific example of process (550) of
In some examples, certain features of the fetal heart rate satisfying respective threshold(s) may be correlated to an increase in fetal pH blood levels and thus processed by the associated ML model to predict an increase in fetal pH blood levels. For example, an increase in the fetal heart rate satisfying one or more thresholds may be determined during training of the ML model to be correlated to a predicted increase in fetal pH blood levels. The one or more thresholds may include, for example, a specified increase/decrease in the frequency of the fetal heart rate, a specified increase/decrease in the amplitude of the fetal heart rate, a specified increase/decrease in the frequency of the fetal ECG signal, a specified increase/decrease in the amplitude of the fetal ECG signal, etc. In addition, a prediction of an increase in fetal pH blood levels may be further correlated to a predicted risk of preeclampsia and/or C-section outcomes. Conversely, training of the one or more ML models may reveal that certain features or combinations of features are indicative that a C-section is not indicated. In such cases, unnecessary C-sections and associated medical costs, along with increased recovery time for the mother, may be avoided.
In some examples, the computing device may compare patient data obtained during a current monitoring session to corresponding baseline(s) established for the patient based on patient data obtained during one or more previous monitoring sessions. In some examples, the computing device may compare one or more maternal and/or fetal outcomes predicted based on data obtained during a current monitoring session to corresponding baseline(s) established for the patient based on one or more maternal and/or fetal outcomes predicted based on data gathered during one or more previous monitoring sessions.
If one or more of the predicted outcomes determined over time for the plurality of monitoring sessions is not consistent (NO branch of 608), the computing device identifies one or more changes in the patient data for the patient over time for the plurality of monitoring sessions (612). The purpose of identifying these changes is to determine whether any of those changes may have resulted in the inconsistency in the predicted outcomes. For example, if a change to fetal heart rate variability (or any other feature(s) or parameter(s)) is detected from a first monitoring session to a second monitoring session, this may account for the change in one or more predicted outcomes from the first monitoring session as compared to the second monitoring session. The computing device generates one or more reports including an indication of the inconsistent predicted outcomes for the patient determined over time for the plurality of monitoring sessions and the one or more changes in the data detected over time for the plurality of monitoring sessions (614). By so doing, the techniques of the disclosure inform the clinicians/providers that changes to the health status of the mother and/or the fetus have occurred, facilitating rapid interventions if necessary, and helping to improve pregnancy outcomes for both mother and fetus.
The process (600) may be repeated each time another monitoring session is performed to continue longitudinal monitoring of the patient.
Additional examples of components, devices, apparatus, methods, and/or systems which may be used in connection with one or more aspects of this disclosure are described in U.S. Pat. No. 9,579,055, issued Feb. 28, 2017, U.S. Pat. No. 10,292,652, issued May 21, 2019, and United States Patent Application Publication No. 2020/0113470, published on Apr. 16, 2020, each of which is incorporated herein by reference in its entirety.
In one or more examples, the functions described may be implemented in any combination of processing circuitry, including hardware, software, firmware, or any combination thereof. If implemented in software, the functions may be stored on or transmitted over a computer-readable medium as one or more instructions or code and executed by a hardware-based processing unit. Computer-readable media may include computer-readable storage media, which corresponds to a tangible medium such as data storage media, or communication media including any medium that facilitates transfer of a computer program from one place to another, e.g., according to a communication protocol. In this manner, computer-readable media generally may correspond to (1) tangible computer-readable storage media which is non-transitory or (2) a communication medium such as a signal or carrier wave. Data storage media may be any available media that can be accessed by one or more computers or one or more processors to retrieve instructions, code and/or data structures for implementation of the techniques described in this disclosure. A computer program product may include a computer-readable medium.
By way of example, and not limitation, such computer-readable storage media can include RAM, ROM, EEPROM, CD-ROM or other optical disk storage, magnetic disk storage, or other magnetic storage devices, flash memory, or any other medium that can be used to store program code in the form of instructions or data structures and that can be accessed by a computer. Also, any connection is properly termed a computer-readable medium. For example, if instructions are transmitted from a website, server, or other remote source using a coaxial cable, fiber optic cable, twisted pair, digital subscriber line (DSL), or wireless technologies such as infrared, radio, and microwave, then the coaxial cable, fiber optic cable, twisted pair, DSL, or wireless technologies such as infrared, radio, and microwave are included in the definition of medium. It should be understood, however, that computer-readable storage media and data storage media do not include connections, carrier waves, signals, or other transitory media, but are instead directed to non-transitory, tangible storage media. Disk and disc, as used herein, includes compact disc (CD), laser disc, optical disc, digital versatile disc (DVD), floppy disk and Blu-ray disc, where disks usually reproduce data magnetically, while discs reproduce data optically with lasers. Combinations of the above should also be included within the scope of computer-readable media.
Instructions may be executed by one or more processors, such as one or more DSPs, general purpose microprocessors and/or microcontrollers, ASICs, FPGAs, or other equivalent integrated or discrete logic circuitry, as well as any combination of such components. Accordingly, the term “processor,” as used herein may refer to any of the foregoing structures or any other structure suitable for implementation of the techniques described herein. In addition, in some aspects, the functionality described herein may be provided within dedicated hardware and/or software modules. Also, the techniques could be fully implemented in one or more circuits or logic elements.
The techniques of this disclosure may be implemented in a wide variety of devices or apparatuses, including a wireless communication device, a microprocessor, an integrated circuit (IC) or a set of ICs (e.g., a chip set). Various components, modules, or units are described in this disclosure to emphasize functional aspects of devices configured to perform the disclosed techniques, but do not necessarily require realization by different hardware units. Rather, as described above, various units may be combined in a hardware unit or provided by a collection of interoperative hardware units, including one or more processors as described above, in conjunction with suitable software and/or firmware, and/or any other type or combination of processing circuitry.
Various examples have been described. These and other examples are within the scope of the following claims.
This application claims the benefit of U.S. Provisional Application No. 63/123,443 filed Dec. 9, 2020, which is incorporated by reference herein in its entirety.
| Number | Date | Country | |
|---|---|---|---|
| 63123443 | Dec 2020 | US |
